Transradial access for PCI (TRI) along with same day discharge (SDD) is
associated with varying estimates of cost savings depending on the population
studied, the clinical scenario and application to low-risk vs high-risk patients.
A summary estimate of the true cost savings of TRI and SDD are unknown. We
searched the PubMed, EMBASE®, CINAHL® and Google
Scholar® databases for published studies on hospitalization costs
of TRI and SDD. Primary outcome of interest in all included studies was the cost
saving with TRI (or SDD), inflation-corrected US 2018 values using the medical
consumer price index. For meta-analytic synthesis, we used Hedges’ summary
estimate (g) in a random-effects framework of the DerSimonian and Laird model,
with inverse variance weights. Heterogeneity was quantified using the I
statistic. The cost savings of TRI from four US studies of 349,757 patients
reported a consistent and significant cost saving associated with TRI after
accounting for currency inflation, of US 992 (95% CI US 850–1,134). The
cost savings of SDD from six US studies of 1,281,228 patients, after
inflation-correcting to the year 2018, were US 3,567.58 (95% CI US
2,303–4,832). In conclusion, this meta-analysis demonstrates that TRI and SDD
are associated with mean cost reductions of by approximately US 1,000/patient
and US 3,600/patient, respectively, albeit with wide heterogeneity in the cost
estimates. When combined with the safety of TRI and SDD, this meta-analysis
underscores the value of combining TRI and SDD pathways and calls for a
wide-ranging practice change in the direction of TRI and SDD.