Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
Cardiology Department, Alfred Hospital, Melbourne, Victoria, Australia.
Clin Cardiol. 2022 Apr;45(4):435-446. doi: 10.1002/clc.23798. Epub 2022 Feb 22.
Despite evidence of the comparative benefits of transradial access percutaneous coronary intervention (PCI) over transfemoral access, its uptake remains highly varied across Australia. Few studies have explored the implications of the choice of access site during PCI from the perspective of the Australian healthcare setting. We, therefore, performed a cost-effectiveness analysis of radial versus femoral access PCI.
Data from the Victorian Cardiac Outcomes Registry (VCOR) were used to inform our economic analyses. Patients treated through either radial or femoral access PCI were propensity score-matched using the inverse probability weighted (IPW) method, and the incidence of major bleeding and all-cause mortality in the cohort was used to inform an economic model comprising a hypothetical sample of 1000 patients. Costs and utility data were drawn from published sources. The economic evaluation adopted the perspective of the Australian healthcare system.
Among a cohort of 1000 patients over 1 year, there were 19 fewer deaths, and six fewer episodes of nonfatal major bleeding in the radial group compared to the femoral group. Total cost savings attributed to radial access was AUD $1 214 688. 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 is associated with improved patient outcomes and considerably lower costs relative to femoral access PCI. Our findings support radial access being the preferred approach for PCI across a variety of indications in Australia.
尽管经桡动脉入路经皮冠状动脉介入治疗（PCI）相对于经股动脉入路具有明显的优势，但在澳大利亚，其应用仍存在很大差异。很少有研究从澳大利亚医疗保健环境的角度探讨 PCI 中入路选择的影响。因此，我们对桡动脉与股动脉入路 PCI 的成本效益进行了分析。
维多利亚心脏结局注册处（VCOR）的数据被用于我们的经济分析。使用逆概率加权（IPW）方法对经桡动脉或股动脉入路 PCI 治疗的患者进行倾向评分匹配，并根据该队列中主要出血和全因死亡率的发生率，为一个包含 1000 例患者的假设样本的经济模型提供信息。成本和效用数据来自已发表的来源。该经济评估采用澳大利亚医疗保健系统的观点。
在为期 1 年的 1000 例患者队列中，与股动脉组相比，桡动脉组的死亡人数减少了 19 例，非致命性大出血事件减少了 6 例。桡动脉入路的总节省成本为 1214688 澳元。因此，从健康经济学的角度来看，桡动脉入路 PCI 优于股动脉入路 PCI。敏感性分析支持这些发现的稳健性。
与股动脉入路 PCI 相比，桡动脉入路与改善的患者结局和显著降低的成本相关。我们的研究结果支持在澳大利亚，桡动脉入路成为各种适应证中 PCI 的首选方法。
