Same versus next day discharge after elective transradial PCI: the RadialSame Day Discharge after PCI trial. (The RASADDA-PCI trial)
January 10, 2020
THE HEALTH ECONOMICS QUESTION STUDIED
Transradial percutaneous coronary intervention (TR-PCI) has been increasingly used during the last decade, with at least a 13-fold increase. (now 1 in 6 elective PCI). TR-PCI offers improved patient satisfaction and significant cost reductions for PCI procedures. Prior studies have shown that same-day discharge (SDD) after elective PCI is just as safe as overnight (ON) observation. This study assessed the clinical and financial impact of early discharge in patients undergoing TR-PCI (as a single center experience).
This was a single center registry analysis of patients undergoing elective TR-PCI. Timing of discharge was determined by the treating physician. (Groups: Same Day Discharge –SD-; Overnight Stay –ON-). Outcomes included 30 day-MACE and procedure-related complications, as well as total operative costs. Propensity score matching for patient demographics, coronary symptoms and procedure indicators was used to compare both groups.
This was the largest single center registry data in USA that initially aimed to analyze data from 1000 patients and included 852 patients (429 in SD group and 423 in ON group) in interim analysis. After propensity scoring the analysis was performed on 245 patients in both groups. The groups were well-balanced in their demographic and clinical characteristics. The statistical power both for clinical outcome at 30 day and cost effectiveness endpoints were reached at that time, and the registry was prematurely stopped.
A) The clinical outcomes at 30 days did not show any difference between 2 groups.
B) Additionally, SDD patients both at discharge and 30 days had a significantly lower procedure-related cost.
HEALTH ECONOMICS IMPLICATIONS
There does not appear to be any additional clinical benefits of late discharge of patients during the first 30 days post-procedure. Early discharge may be a more cost-effective approach in stable patients undergoing elective TR-PCI with up to 28% cost reduction per procedure. In elective patients undergoing low risk TRPCI, same-day discharge seems to be safe and feasible, with significant potential savings to the healthcare system.
About the Author
Sr. Strategic Business Account Manager
Terumo Health Outcomes
As Strategic Business Account Manager, John assists hospitals in understanding the full financial impact of their care pathway redesign and their ROI. John earned a Master’s Degree in Business from Montclair State University, and has spent over 15 years in the health care fields of cardiology, electrophysiology, orthopedics, and diagnostic imaging. He has worked closely with hospital leadership to develop programs focused on the economic costs of healthcare procedures, including initiating radial adoption, creating reprocessing initiatives and establishing value-based contracts.