Hemodialysis patients and complications management costs in Italy: Plastic cannulae a potentially cost-effective strategy

Abstract

Background: The treatment of end-stage chronic renal failure involves substantial costs for health care, which could be higher considering hemodialysis access complications management costs. Complications could be addressed by cannulation technique, but also by the needle. In particular, the use of a metal needle for cannulation is responsible for several complications that compromise dialysis delivery and require interventions. This analysis aims to evaluate, from a hospital perspective, the direct costs related to complications that may occur in hemodialysis patients in Italy. Methods: To identify the main complications to consider in our analysis and related patient pathway for their management, we conducted an international literature search on PubMed and validated the data for Italy with an Italian Key Opinion Leader (KOL). A micro-costing analysis was developed to precisely assess the economic costs of healthcare interventions to manage complications due to vascular access cannulation. Results: The major complications identified, and the average cost/per episode for their management are the following ones: Local infection € 1455 (min € 745 and max € 2160); Sepsis, that requires hospitalization in ward € 4401 (min € 3693 and max € 4623); Sepsis (ICU) € 17,190; Hematoma € 304 (min € 252 and max € 728); Aneurysm € 3632 (min € 3139 and max € 4014); Pseudoaneurysm € 3695 (min € 3615 and max € 4014); Stenosis € 2229 (min € 1874 and max € 4857); Thrombosis € 2151 (min € 1941 and max € 3395). Conclusions: In making decisions, hospital administration, and payer should take into consideration, not just the price of devices, but the entire patient’s pathway. The use of plastic cannulae in hemodialysis patients shows improved outcomes compared to traditional metal needles. Furthermore, combining it with accurate and efficient cannulation techniques reduces complication rates, improves patients’ quality of life, and reduces healthcare resource consumption.

The knowledge, attitudes, and practices of arteriovenous access assessment among hemodialysis nurses: A multicenter cross‐sectional survey

“…2 Unfortunately, arteriovenous access failure can lead to severe consequences for hemodialysis patients, including an increased risk of hospitalization, increased mortality rates, and significant health care cost burdens. 3,4 Various factors affect the patency of arteriovenous access: patient characteristics such as age, health status, and self-care practices; the surgical method utilized for placement; monitoring and surveillance; and cannulation and maintenance programs used in practice. 5,6 An arteriovenous access assessment comprises a medical history and vascular assessment through physical examination and surveillance.…”

“…Nearly 88.2% of hemodialysis patients in China choose arteriovenous access as their first option for vascular access 2 . Unfortunately, arteriovenous access failure can lead to severe consequences for hemodialysis patients, including an increased risk of hospitalization, increased mortality rates, and significant health care cost burdens 3,4 . Various factors affect the patency of arteriovenous access: patient characteristics such as age, health status, and self‐care practices; the surgical method utilized for placement; monitoring and surveillance; and cannulation and maintenance programs used in practice 5,6 …”