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J Vasc Interv Radiol. 2018 Nov;29(11):1558-1566.e2. doi: 10.1016/j.jvir.2018.05.014. Epub 2018 Oct 5.

Comparison between Surgical and Endovascular Hemodialysis Arteriovenous Fistula Interventions and Associated Costs.

Author information

1
Navigant Consulting, San Francisco, California; Icahn School of Medicine at Mount Sinai, New York, New York.
2
University of Michigan, Ann Arbor, Michigan.
3
University of Virginia School of Medicine, Charlottesville, Virginia.
4
Navigant Consulting, San Francisco, California.
5
Division of Vascular and Interventional Radiology, Department of Medical Imaging, University of Toronto, University Health Network, 585 University Avenue, 1-PMB-287, Toronto, Ontario M5G 2N2, Canada.
6
Eastern Virginia Medical School, Virginia Beach, Virginia.
7
Division of Vascular and Interventional Radiology, Department of Medical Imaging, University of Toronto, University Health Network, 585 University Avenue, 1-PMB-287, Toronto, Ontario M5G 2N2, Canada. Electronic address: dheeraj.rajan@uhn.ca.

Abstract

PURPOSE:

To compare: (i) rate of arteriovenous fistula (AVF) interventions in both incident and prevalent end-stage kidney disease patients; (ii) their associated costs; and (iii) intervention-free survival between patients with surgical hemodialysis arteriovenous fistula (SAVF) versus those with an endovascularly created fistula (endoAVF).

MATERIALS AND METHODS:

Data from the United States Renal Data System (USRDS) were abstracted to determine the rate of AVF interventions performed in the first year and associated costs (based on Medicare payment rates) for SAVFs created from 2011 to 2013 in the incident and prevalent patient cohorts. Comparative data for endoAVF were obtained from the Novel Endovascular Access Trial (NEAT). Event rates, intervention-free survival, and costs were compared between endoAVF and SAVF cohorts after 1:1 propensity score (PS) matching.

RESULTS:

In the matched incident patients, the event rate was 0.74 per patient-year (PY) for endoAVF versus 7.22/PY for SAVF (P < .0001), with a difference in expenditures of $16,494. Similarly, in matched prevalent patients the event rate was 0.46/PY for endoAVF vs 4.10/PY for SAVF (P < .0001), resulting in a cost difference of $13,389. Time-to-event analysis showed that at 1 year, 70% of endoAVF patients experienced freedom from intervention versus only 18% of SAVF patients for incident patients; these numbers were 62% and 18% for endoAVF and SAVF prevalent patients, respectively (P < .0001 for both).

CONCLUSIONS:

Both incident and prevalent patients with endoAVF required fewer interventions and had lower costs within the first year compared with matched patients with SAVF.

PMID:
30293731
DOI:
10.1016/j.jvir.2018.05.014
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