What is the Best Setting for Receiving Dialysis Vascular access Repair and Maintenance Services?

Abstract

ORIGINAL RESEARCH ARTICLEangioplasties performed on AVF (3). Site of service has also changed progressively toward the freestanding outpatient facility (FOC) dedicated to DVA from hospital outpatient departments (HOPD). In the FOC, fluoroscopically guided, endovascular treatments are being performed, utilizing sedation/ analgesia in an outpatient environment primarily by interventional nephrologists. Questions arise about their effectiveness, safety, quality, and economy.In a previous study (4), based on Medicare claims and United States Renal Data System (USRDS) data from 2006 to 2009, a large cohort of cases receiving DVA management care in an FOC was compared using propensity score matching with a cohort of cases managed in an HOPD. This study showed significantly better outcomes for the FOC setting, including fewer vascular access-related infections, fewer septicemia-related hospital admissions, and fewer related and unrelated hospital admissions than those who received care in a HOPD (p<0.001 for each metric). Furthermore, FOC cases had significantly lower mortality and lower per-member-per-month (PMPM) Medicare payments than HOPD cases.

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

“…Although we compared endoAVF costs with SAVF costs, there are limited studies within the SAVF literature comparing different AVF anastomotic techniques and associated cost of maintenance with SAVF (24). El-Gamil et al used USRDS to compare vascular access costs in freestanding office-based centers with the hospital outpatient department, but they combined SAVF and AVG outcomes, so the results can not be compared with the present study (25,26). Another recent study, by Al-Balas et al, quantified intervention rates and costs by access type in incident patients starting dialysis with a CVC and found 2.48 procedures per PY were needed to mature and maintain a surgical AVF with a median first year cost of $16,602 (10).…”

Safety and efficacy of arteriovenous fistula angioplasties performed by nephrologists: report from a Brazilian interventional nephrology center

“…In the United States of America (USA), AVF angioplasties are commonly performed by nephrologists in specialized outpatient centers, with lower complication rates, shorter hospital stay, lower costs, and fewer infection episodes compared to inpatient treatment. However, in developing countries, most nephrologists are not trained to perform this type of interventional procedure, which might affect AV outcomes [3][4][5][6] . An important obstacle in these countries and in low-resource settings is the lack of training in endovascular procedures for nephrologists.…”