Shroff A - AIMRADIAL 2013 - Cost effectiveness
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Economic analyses for transradial procedures
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Shroff A - AIMRADIAL 2013 - Cost effectiveness
- 1. Economic Analyses for Transradial Procedures Adhir Shroff, MD, MPH Associate Professor of Medicine University of Illinois – Chicago Jesse Brown VA Medical Center arshroff@uic.edu
- 2. 2 The Value Equation in Healthcare ✓ ✓ ✓ Value Superior Outcomes PatientCentered Care Efficiency At Lower Cost The New Economics of Quality. Advisory Board 2011 Adhir Shroff, MD, MPH Associate Professor of Medicine
- 3. 3 Primary Economic Drivers… • Less bleeding and vascular complications with transradial procedures…Avoidance of complications • Access site closure is very reliable….Reduce workload • Earlier mobilization of the patient following the procedure…Decrease length of stay Adhir Shroff, MD, MPH Associate Professor of Medicine
- 4. Adhir Shroff, MD, MPH Associate Professor of Medicine
- 5. 5 Economics of TR: Premier Registry • Analyzed PCI cases from 2004-9 • 609 TR-PCI cases matched with 60,000 TF-PCI • Primary endpoint included total hospital costs • Stratified patients into low, middle and high risk for periprocedural bleeding • In hospital bleeding (1.5% TR, 2.3% TF) TR Total Inpatient Costs TF $12,400 $12,200 $12,288 P = .033 $12,000 $11,800 $11,736 $11,600 $11,400 TR TF Am Heart J 2013;165:303-309.e2 Adhir Shroff, MD, MPH Associate Professor of Medicine
- 6. 6 Economics of TR: Premier Registry Post-procedure LOS Am Heart J 2013;165:303-309.e2 Adhir Shroff, MD, MPH Associate Professor of Medicine
- 7. 7 Economics of TR: Premier Registry TOTAL Costs Am Heart J 2013;165:303-309.e2 Adhir Shroff, MD, MPH Associate Professor of Medicine
- 8. 8 Economics of TR: Premier Registry DAY OF PROCEDURE Costs Am Heart J 2013;165:303-309.e2 Adhir Shroff, MD, MPH Associate Professor of Medicine
- 9. 9 Economics of TR: Premier Registry POST PCI UNTIL DISCHARGE Costs Am Heart J 2013;165:303-309.e2 Adhir Shroff, MD, MPH Associate Professor of Medicine
- 10. US: Real-world Experience • 7121 PCI procedures from 5 US centers, retrospective • Primary outcomes was cost of PCI hospitalization • Direct and indirect costs combined into a Total cost • Patients stratified into bleeding risk categories using the NCDR CathPCI risk model • LOS was 0.5d less in TR group TR Group • Less STEMI, less emergent cases • More GPI, less bival • Shifted towards lower bleeding risk patients • More outpatients, same-day dc Amin, et al. J Am Coll Cardiol Intv 2013;6:827–34 Adhir Shroff, MD, MPH Associate Professor of Medicine
- 11. US: Real-world Experience $19,000 p<0.001 p<0.035 p<0.029 p<0.038 $18,000 $17,776 $17,000 $16,000 $15,000 $14,954 $16,115 $15,867 $15,784 $15,161 Radial $14,716 Femoral $14,074 $14,000 $13,000 $12,000 All Low (<1%) Moderate (1-3%) High (>3%) NCDR Bleeding Risk Amin, et al. J Am Coll Cardiol Intv 2013;6:827–34 Adhir Shroff, MD, MPH Associate Professor of Medicine
- 12. 12 Meta-analysis of TR vs TF Trials CE Trials Circ Cardiovasc Qual Outcomes. 2012;5:454-462. Adhir Shroff, MD, MPH Associate Professor of Medicine
- 13. 13 Meta-analysis of TR vs TF Trials CE Trials Circ Cardiovasc Qual Outcomes. 2012;5:454-462. Adhir Shroff, MD, MPH Associate Professor of Medicine
- 14. 14 Meta-analysis of TR vs TF Trials CE Trials Circ Cardiovasc Qual Outcomes. 2012;5:454-462. Adhir Shroff, MD, MPH Associate Professor of Medicine
- 15. Adhir Shroff, MD, MPH Associate Professor of Medicine
- 16. 16 Economics of TR: SD-DC • 370 elective PCI patients • 3 high-volume PCI centers in France ▫ 52.3% patients with multivessel coronary artery disease ▫ 22.7% patients with multilesion procedures ▫ 21.5% bifurcation lesions • At 24hrs, no MACE • At 1 month, 4 (1.9%) readmitted Catheterization and Cardiovascular Interventions 81:15–23 (2013) Adhir Shroff, MD, MPH Associate Professor of Medicine
- 17. 17 Economics of TR: SD-DC • 370 elective PCI patients • 3 high-volume PCI centers in France ▫ 52.3% patients with multivessel coronary artery disease ▫ 22.7% patients with multilesion procedures ▫ 21.5% bifurcation lesions • At 24hrs, no MACE • At 1 month, 4 (1.9%) readmitted • Significant cost-saving for SDDC € 2,500 € 1,214 € 1,634 € 2,304 p<10-6 € 2,000 € 1,500 € 1,000 € 500 €SD-DC Prolonged stay Conventional PCI Overhead & bed charges Drugs, supplies Personnel Catheterization and Cardiovascular Interventions 81:15–23 (2013) Adhir Shroff, MD, MPH Associate Professor of Medicine
- 18. 18 Same-Day PCI Discharge Program EASY Trial Same-day discharge (No infusion) Uncomplicated TR-PCI with abciximab bolus 8.9hrs DC C$1004 DC C$3117 ® Overnight stay (+ infusion) 26.5 hrs Average savings of C$2,113 per patient with same-day d/c Circulation. 2008;118:S_1119 Adhir Shroff, MD, MPH Associate Professor of Medicine
- 19. 19 Outpatient PCI at UIHHSS: Costs Payor Mix Mean Variable Cost Expenses that vary with volume: Mean Direct Fixed Cost Total • Cath lab staff labor Expenses that do not vary with volume: • Supplies: stents, medications, VCD • Admin staff salaries • Medications • Capital depreciation Transfemoral (n=5) 4/5 Government Transradial (n=8) 4/8 Government Cost savings 1/5 Private 4/8 Private $8,856 $3,858 $12,714 $7,478 $3,519 $10,997 $1,378 $338 $1,716 13% Sample of OP-PCI cases from January 2011 – March 2011 Adhir Shroff, MD, MPH Associate Professor of Medicine
- 20. Adhir Shroff, MD, MPH Associate Professor of Medicine
- 21. PPCI for STEMI: Access Site and Clinical Events RIFLE-STEACS J Am Coll Cardiol 2012;60:2481–9 RIVAL-STEMI J Am Coll Cardiol 2012;60:2490–9 Adhir Shroff, MD, MPH Associate Professor of Medicine
- 22. PPCI for STEMI: Access Site and LOS RADIAL Single Center (Greece) Total LOS FEMORAL N=65 N=33 6 ± 3.2 d 7.1 ± 2.8 d < 0.05 Deftereos S, et al. Hellenic J Cardiol 2011; 52: 111-117 Single Center (US) N=46 N=104 Total LOS 3 (2-5) d 4 (3-5) d 0.112 Ibebuogu UN, et al. Am J Cardiol 2012;110:1262–1265 Meta-analysis (Jang JS, et al) From 8 trials, TR approach associated with a 2.23 days shorter LOS <0.001 Jang JS, et al. EuroIntervention 2012;8:501-510 Adhir Shroff, MD, MPH Associate Professor of Medicine
- 23. PPCI for STEMI: Access Site and LOS RADIAL FEMORAL N=6,159 N=84,720 Less than 2d 0.93% 1.23% Between 2 and 4d 48.7% 40.5% ≥4d 50.4% 58.3% NCDR <0.0001 Unpublished data, personal communication from S Rao N=500 N=501 CCU 3d 4d <0.001 Total 5d 6d 0.008 RIFLE Romagnoli E, et al. J Am Coll Cardiol 2012;60:2481–9 Adhir Shroff, MD, MPH Associate Professor of Medicine
- 24. 24 Conclusions ✓ Value ✓ ✓ ✓ Superior Outcomes PatientCentered Care Efficiency At Lower Cost • TR access for PCI can favorably impact economics: ▫ By improving clinical outcomes ▫ By safely decreasing LOS • Utilization of the transradial approach creates value across a spectrum of clinical scenarios Adhir Shroff, MD, MPH Associate Professor of Medicine
- 25. 25 arshroff@uic.edu 312-485-4511 Adhir Shroff, MD, MPH Associate Professor of Medicine
- 26. Adhir Shroff, MD, MPH Associate Professor of Medicine
- 27. Adhir Shroff, MD, MPH Associate Professor of Medicine
Notes de l'éditeur
- Mean estimatedpost-PCI hospital costs (including abciximab infusion when used,other medications, nursing time, meals, etc..) were $1004 ($929–$1079)in the SDD group versus $3117 ($2975–$3260) in the OHgroup, saving, on average, $2113 per patient (p<0.001).