Mae Thamer1, Timmy C Lee2, Haimanot Wasse3, Marc H Glickman4, Joyce Qian1, Daniel Gottlieb5, Scott Toner5, Timothy A Pflederer6. 1. Medical Technology & Practice Patterns Institute, Bethesda, MD. 2. Department of Nephrology, University of Alabama at Birmingham, Birmingham, AL. 3. Division of Nephrology, Rush University Medical Center, Chicago, IL. 4. Hancock Jaffe Laboratories, Irvine, CA. 5. Proteon Therapeutics, Inc, Waltham, MA. 6. Illinois Kidney Disease and Hypertension Center, Peoria, IL. Electronic address: tap@renalcareassoc.com.
Abstract
BACKGROUND: An arteriovenous fistula (AVF) is the recommended vascular access for hemodialysis (HD). Previous studies have not examined the resources and costs associated with creating and maintaining AVFs. STUDY DESIGN: Retrospective observational study. SETTING & PARTICIPANTS: Elderly US Medicare patients initiating hemodialysis therapy during 2010 to 2011. PREDICTOR: AVF primary and secondary patency and nonuse in the first year following AVF creation. OUTCOMES: Annualized vascular access costs per patient per year. RESULTS: Among patients with only a catheter at HD therapy initiation, only 54% of AVFs were successfully used for HD, 10% were used but experienced secondary patency loss within 1 year of creation, and 83% experienced primary patency loss within 1 year of creation. Mean vascular access costs per patient per year in the 2.5 years after AVF creation were $7,871 for AVFs that maintained primary patency in year 1, $13,282 for AVFs that experienced primary patency loss in year 1, $17,808 for AVFs that experienced secondary patency loss in year 1, and $31,630 for AVFs that were not used. Similar patterns were seen among patients with a mature AVF at HD therapy initiation and patients with a catheter and maturing AVF at HD therapy initiation. Overall, in 2013, fee-for-service Medicare paid $2.8 billion for dialysis vascular access-related services, ∼12% of all end-stage renal disease payments. LIMITATIONS: Lack of granularity with certain billing codes. CONCLUSIONS: AVF failure in the first year after creation is common and results in substantially higher health care costs. Compared with patients whose AVFs maintained primary patency, vascular access costs were 2 to 3 times higher for patients whose AVFs experienced primary or secondary patency loss and 4 times higher for patients who never used their AVFs. There is a need to improve AVF outcomes and reduce costs after AVF creation.
BACKGROUND: An arteriovenous fistula (AVF) is the recommended vascular access for hemodialysis (HD). Previous studies have not examined the resources and costs associated with creating and maintaining AVFs. STUDY DESIGN: Retrospective observational study. SETTING & PARTICIPANTS: Elderly US Medicare patients initiating hemodialysis therapy during 2010 to 2011. PREDICTOR: AVF primary and secondary patency and nonuse in the first year following AVF creation. OUTCOMES: Annualized vascular access costs per patient per year. RESULTS: Among patients with only a catheter at HD therapy initiation, only 54% of AVFs were successfully used for HD, 10% were used but experienced secondary patency loss within 1 year of creation, and 83% experienced primary patency loss within 1 year of creation. Mean vascular access costs per patient per year in the 2.5 years after AVF creation were $7,871 for AVFs that maintained primary patency in year 1, $13,282 for AVFs that experienced primary patency loss in year 1, $17,808 for AVFs that experienced secondary patency loss in year 1, and $31,630 for AVFs that were not used. Similar patterns were seen among patients with a mature AVF at HD therapy initiation and patients with a catheter and maturing AVF at HD therapy initiation. Overall, in 2013, fee-for-service Medicare paid $2.8 billion for dialysis vascular access-related services, ∼12% of all end-stage renal disease payments. LIMITATIONS: Lack of granularity with certain billing codes. CONCLUSIONS:AVF failure in the first year after creation is common and results in substantially higher health care costs. Compared with patients whose AVFs maintained primary patency, vascular access costs were 2 to 3 times higher for patients whose AVFs experienced primary or secondary patency loss and 4 times higher for patients who never used their AVFs. There is a need to improve AVF outcomes and reduce costs after AVF creation.
Authors: Jie Cui; Chase W Kessinger; Harkamal S Jhajj; Madeleine S Grau; Sanjay Misra; Peter Libby; Jason R McCarthy; Farouc A Jaffer Journal: J Am Soc Nephrol Date: 2020-03-09 Impact factor: 10.121
Authors: Shipra Arya; Taylor A Melanson; Elizabeth L George; Kara A Rothenberg; Manjula Kurella Tamura; Rachel E Patzer; Jason M Hockenberry Journal: J Am Soc Nephrol Date: 2020-01-15 Impact factor: 10.121
Authors: Yihao Zheng; Brian J Thelen; Nirmala Rajaram; Venkataramu N Krishnamurthy; James Hamilton; Miguel Angel Funes-Lora; Timothy Morgan; Lenar Yessayan; Brandie Bishop; Nickolas Osborne; Peter Henke; Albert J Shih; William F Weitzel Journal: Ann Biomed Eng Date: 2021-08-11 Impact factor: 3.934