BACKGROUND: The use of an arteriovenous fistula (AVF) for haemodialysis treatment may be associated with a high early failure rate, but usually good long-term patency, while using an arteriovenous graft (AVG) yields a lower early failure rate with worse long-term patency. The aim of this study was to calculate and compare the costs and outcome of AVF and AVG surgery in terms of early and long-term patencies. METHODS: A decision tree and a Markov model were constructed to calculate costs and performance of AVFs and AVGs. The model was populated with a retrospective cohort of HD patients receiving their first VA. The outcomes were determined probabilistically with a 5-year follow-up. RESULTS: AVFs were usable for a mean (95% CI) of 28.5 months (24.6-32.5 months), while AVGs showed a patency of 25.5 months (20.0-31.2 months). The use of AVFs was the dominant type of VA and € 631 could be saved per patient/per month patency compared to AVG use. Regardless of the willingness to pay, the use of AVFs yielded a higher probability of being cost-effective compared to AVGs. CONCLUSIONS: AVFs are more cost-effective than AVGs. Nonetheless, early failure rates significantly influence AVF performance and initiatives to reduce early failure can improve its cost-effectiveness.
BACKGROUND: The use of an arteriovenous fistula (AVF) for haemodialysis treatment may be associated with a high early failure rate, but usually good long-term patency, while using an arteriovenous graft (AVG) yields a lower early failure rate with worse long-term patency. The aim of this study was to calculate and compare the costs and outcome of AVF and AVG surgery in terms of early and long-term patencies. METHODS: A decision tree and a Markov model were constructed to calculate costs and performance of AVFs and AVGs. The model was populated with a retrospective cohort of HDpatients receiving their first VA. The outcomes were determined probabilistically with a 5-year follow-up. RESULTS: AVFs were usable for a mean (95% CI) of 28.5 months (24.6-32.5 months), while AVGs showed a patency of 25.5 months (20.0-31.2 months). The use of AVFs was the dominant type of VA and € 631 could be saved per patient/per month patency compared to AVG use. Regardless of the willingness to pay, the use of AVFs yielded a higher probability of being cost-effective compared to AVGs. CONCLUSIONS: AVFs are more cost-effective than AVGs. Nonetheless, early failure rates significantly influence AVF performance and initiatives to reduce early failure can improve its cost-effectiveness.
Authors: Kenneth J Woodside; Sarah Bell; Purna Mukhopadhyay; Kaitlyn J Repeck; Ian T Robinson; Ashley R Eckard; Sudipta Dasmunshi; Brett W Plattner; Jeffrey Pearson; Douglas E Schaubel; Ronald L Pisoni; Rajiv Saran Journal: Am J Kidney Dis Date: 2018-02-09 Impact factor: 8.860
Authors: Tushar J Vachharajani; Louise M Moist; Marc H Glickman; Miguel A Vazquez; Kevan R Polkinghorne; Charmaine E Lok; Timmy C Lee Journal: Nat Rev Nephrol Date: 2013-12-03 Impact factor: 28.314
Authors: Hye Yun Jeong; Eun Jung Ko; Sang Hoon Kim; Mi Jung Lee; Hye Jeong Cho; Dong Ho Yang; So Young Lee Journal: Yonsei Med J Date: 2017-07 Impact factor: 2.759
Authors: Manuel Carlos Martins Castro; Francisca Tokiko Yanagida Carlquist; Celina de Fátima Silva; Magdaleni Xagoraris; Jerônimo Ruiz Centeno; José Adilson Camargo de Souza Journal: J Bras Nefrol Date: 2019-12-09