Abstract：
UNASSIGNED: Transfemoral access (TFA) is the primary access approach for neurointerventional procedures. Transradial access (TRA) is established in cardiology due to its lower complications, yet, it is at its early stages in neuroprocedures. This study performs an early exploration of the economic impact associated with the introduction of TRA in diagnostic and therapeutic neuroprocedures from the Spanish NHS perspective.
UNASSIGNED: An economic model was developed to estimate the cost and clinical implications of using TRA compared to TFA. Costs considered access-related, complications and recovery time costs obtained from local databases and experts\' inputs. Clinical inputs were sourced from the literature. A panel of eight experts from different Spanish hospitals, validated or adjusted the values based on local experience. Hypothetical cohorts of 10,000 and 1000 patients were considered for diagnostic and therapeutic neuroprocedures respectively. Deterministic sensitivity analysis was performed.
UNASSIGNED: TRA in diagnostic procedures was associated with lower costs with savings ranging between €486 and €157 depending on the TFA recovery time considered. TRA is estimated to lead to 158 fewer access-site complications. In therapeutic procedures, TRA resulted in 76.4 fewer complications and was estimated to be cost-neutral with an incremental cost of €21.56 per patient despite recovery times were not included for this group. Variation of the parameters in the sensitivity analysis did not change the direction of the results.
UNASSIGNED: Clinical data was obtained from literature validated by experts therefore results generalizability is limited. In therapeutic neuroprocedures, there is an experience imbalance between approaches and recovery times were not included hence the total impact is not fully captured.
UNASSIGNED: The early economic model suggests that implementing TRA is associated with reduced costs and complications in diagnostic procedures. In therapeutic procedures, TRA lead to fewer complications and it is estimated to be cost-neutral, however its full potential still needs to be quantified.
UNASSIGNED: An economic model was developed to estimate the cost and clinical implications of using TRA compared to TFA. Costs considered access-related, complications and recovery time costs obtained from local databases and experts\' inputs. Clinical inputs were sourced from the literature. A panel of eight experts from different Spanish hospitals, validated or adjusted the values based on local experience. Hypothetical cohorts of 10,000 and 1000 patients were considered for diagnostic and therapeutic neuroprocedures respectively. Deterministic sensitivity analysis was performed.
UNASSIGNED: TRA in diagnostic procedures was associated with lower costs with savings ranging between €486 and €157 depending on the TFA recovery time considered. TRA is estimated to lead to 158 fewer access-site complications. In therapeutic procedures, TRA resulted in 76.4 fewer complications and was estimated to be cost-neutral with an incremental cost of €21.56 per patient despite recovery times were not included for this group. Variation of the parameters in the sensitivity analysis did not change the direction of the results.
UNASSIGNED: Clinical data was obtained from literature validated by experts therefore results generalizability is limited. In therapeutic neuroprocedures, there is an experience imbalance between approaches and recovery times were not included hence the total impact is not fully captured.
UNASSIGNED: The early economic model suggests that implementing TRA is associated with reduced costs and complications in diagnostic procedures. In therapeutic procedures, TRA lead to fewer complications and it is estimated to be cost-neutral, however its full potential still needs to be quantified.
摘要：
引言经股动脉入路(TFA)是神经介入手术的主要入路。经桡动脉入路（TRA）由于其并发症较低而在心脏病学中建立，然而，它处于神经手术的早期阶段。这项研究从西班牙NHS的角度对与在诊断和治疗神经程序中引入TRA相关的经济影响进行了早期探索。方法开发了一个经济模型来估计使用TRA与TFA相比的成本和临床意义。考虑与访问相关的成本，从当地数据库和专家输入中获得的并发症和恢复时间成本。临床输入来自文献。来自西班牙不同医院的八名专家组成的小组，根据当地经验验证或调整值。分别考虑了10,000和1,000名患者的假设队列用于诊断和治疗性神经程序。进行确定性敏感性分析。结果诊断程序中的TRA与较低的成本相关，根据所考虑的TFA恢复时间，节省的费用在486欧元至157欧元之间。估计TRA可减少158例进入部位并发症。在治疗程序中，TRA减少了76.4例并发症，估计成本中性，每位患者的增量成本为21.56欧元，尽管该组未包括恢复时间。敏感性分析中参数的变化并没有改变结果的方向。局限性临床数据来自专家验证的文献,因此结果的可推广性有限。在治疗性神经程序中，方法和恢复时间之间存在经验不平衡，因此总影响未被完全捕获。结论早期的经济模型表明，实施TRA可以降低诊断程序的成本和并发症。在治疗程序中，TRA导致更少的并发症，估计是成本中性的，然而，它的全部潜力仍然需要量化。
