Hemodialysis access cost comparisons among incident tunneled catheter patients
| Autor: | Jason K. Wagner, Steven D. Weisbord, Larry Fish, Theodore H. Yuo |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Male
Catheterization Central Venous medicine.medical_specialty Time Factors Databases Factual Arteriovenous fistula Medicare Blood Vessel Prosthesis Implantation Arteriovenous Shunt Surgical Renal Dialysis Risk Factors Humans Medicine Tunneled catheter Hemodialysis access Aged Retrospective Studies Cost comparison business.industry Graft Occlusion Vascular Health Care Costs Dialysis catheter Middle Aged medicine.disease United States Surgery Outcome and Process Assessment Health Care Treatment Outcome Nephrology Female business |
| Zdroj: | The Journal of Vascular Access. 21:308-313 |
| ISSN: | 1724-6032 1129-7298 |
| Popis: | Background:Arteriovenous fistula is the ideal hemodialysis access, but most patients start with tunneled dialysis catheter. Arteriovenous fistula and arteriovenous graft surgery may reduce tunneled dialysis catheter use and also increase procedural expenses. We compared Medicare costs associated with arteriovenous fistula, arteriovenous graft, and tunneled dialysis catheter.Methods:Using the US Renal Data System, we identified incident hemodialysis patients in 2008 who started with tunneled dialysis catheter, survived at least 90 days, and had adequate Medicare records for analysis. We followed them until death or end of 2011; access modality was based on billing evidence of arteriovenous fistula or arteriovenous graft creation. We assumed patients without such records remained with tunneled dialysis catheter. We generated multivariate linear regression models predicting Medicare expenditures, censoring costs when patients died; we included all payments to physicians and institutions. We also created algorithms to identify access-related costs.Results:There were 113,505 patients in the US Renal Data System who started hemodialysis in 2008, of whom 51,002 Medicare patients met inclusion criteria. Of that group, 41,532 (81%) began with tunneled dialysis catheter; 27,064 patients were in the final analysis file. In the first 90 days after hemodialysis initiation, 6100 (22.5%) received arteriovenous fistula, 1813 (6.7%) arteriovenous graft, and 19,151 (70.8%) stayed with tunneled dialysis catheter. Annualized access costs by modality were tunneled dialysis catheter US$13,625 (95% confidence interval: US$13,426–US$13,285); arteriovenous fistula US$16,864 (95% confidence interval: US$16,533–US$17,194); and arteriovenous graft US$20,961 (95% confidence interval: US$20,967–US$21,654; p Conclusions:Among patients starting hemodialysis with tunneled dialysis catheter, continued tunneled dialysis catheter use is associated with lowest access-related cost. Both endovascular and open interventions are associated with significant additional costs. Further investigation is warranted to develop efficient patient-centered strategies for hemodialysis access. |
| Databáze: | OpenAIRE |
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