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

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.

Endovascular versus surgical creation of arteriovenous fistula in hemodialysis patients: Cost-effectiveness and budget impact analyses

“…Two studies, 17,39 which considered WavelinQ device, directly compared the two AVF creation procedures through propensity score matching (PSM) technique. On the remaining single-arm studies, sixteen, mainly retrospective, reported data on SAVF, while eight studies focused on endoAVF (four on WavelinQ and four on Ellipsys).…”

“…29 However, information on incident and prevalent status could not be evaluated with Medicare. The second study 17 considered endoAVF (WavelinQ) data from the same NEAT trial, while data on SAVF were retrieved from the United States Renal Data System (USRDS). This study has carried out the comparative analysis between WavelinQ and surgical procedure by distinguishing incident and prevalent dialysis patients and it has been chosen as the source for developing the model in our study in order to perform the economic evaluations.…”

“…A 1-1 PSM has been performed to compare event rates, intervention-free survival, and costs between endoAVF and SAVF cohorts, leading to a comparison of 27 and 33 for incident and prevalent patients, respectively. 17 Table 3 reports the rates of events distinguished by cohort and population.…”

WavelinQ created arteriovenous fistulas versus surgical radiocephalic arteriovenous fistulas? A single-centre observational study

“…Evolving data have supported their use when compared with a surgically created brachiocephalic AVF as the clinical outcomes are at least equivalent if not superior. 10,18 The data from this study may support an endoAVF prior to an RC AVF if suitable anatomy is present. The criteria for RC AVF in this group were a vein and artery > 2 mm and as such the criteria for attempting an RC AVF are less strict than some authors may support.…”

“…Data from prospective observational studies have shown promising results when compared to historic registry data. [10][11][12] While the use of such comparative historical evidence derived from registries may be illustrating and can be the precursor to higher levels of evidence, in the absence of randomised controlled trials (RCTs), single-centre matched cohort studies may provide a more appropriate comparison in a real-world setting. 13 As endoAVFs have shown good results and still retain an ability to perform a subsequent radiocephalic or elbow fistula, the question arises of whether an endoAVF should be performed as a first option.…”