Author + information
Approximately one million diagnostic cardiac catheterizations are performed annually. The Accountable Care Act means that cost savings measures are becoming increasingly more important. Through advances in flat panel X-ray in the cath lab, coronary arteriogram quality has significantly improved for 4French (4F) catheters to allow for daily use in arteriography. Previous Transradial Artery Approach (TRA) studies revealed greater cost effectiveness for TRA due to post procedure care. Studies with 4F Femoral Approach (4FFA) revealed hemostatic devices are never used and patients are able to ambulate in one hour. Post procedure care between 4FFA and TRA are similar and can be compared on equipment used.
To compare cost of both approaches, we analyzed the equipment used for 4FFA and TRA through cost analysis, as most institutions use similar basic packs for both. List prices were analyzed. Costs per 1000 patients were calculated. Accepted practice recognizes that two-three diagnostic catheters are generally used for 4FFA and TRA.
For 4FFA, a small injection syringe (8ml - $6) is needed. For TRA, Micropuncture kit ($46.80), Glide wire ($33.80),TR Band ($32.50), verapamil 2ml ($1.76), nitroglycerine 10 ml ($0.67) and heparin 10ml ($9.09) are used adding additional costs totaling ($124.62). The equipment cost of 4FFA is 2000% less than TRA. Depending on cardiologist equipment preferences, the equipment may be more or less. Recovery time is not affected and post-procedure complications remain the same at our institution.
If TRA is completely adopted, there would be an additional cost expense of $124,620/1000 pts, however, if 4FFA is completely adopted, there would be additional cost expense of $6,000/1000 pts resulting in a total cost savings of $118,620/1000 pts. Fixed and variable costs differ as per institutional purchasing contracts and patient referral sources.
Adoption of 4FFA can save money for institutions performing diagnostic cardiac catheterizations. Potential savings equate to $118 million for the switch in the United States.