Analysis of economic implications of percutaneous and surgical proximal forearm arteriovenous fistula creation: Five-year follow-up data from a single-centre study

Abstract

Introduction:

The current study is the first to analyse long-term costs following both available percutaneous arteriovenous fistula (pAVF) devices and the surgical comparator (sAVF), based on prospectively collected data from a single vascular access centre in Germany.

Methods:

A decision-analytic model tracked reinterventions and costs by index modalities, with total cumulative reintervention burden derived from underlying Kaplan-Meier event rates of all consecutive reinterventions (including AVF-failure) reported over a 5-year analysis horizon. Strategy-specific costs per reintervention event were informed by claims data and number of reinterventions by follow-up year. Costs for initial AVF-creation were not accounted for. Study outcomes were the cumulative reintervention burden and costs.

Results:

A total of 375 AVFs (217 pAVFs and 158 sAVFs) were followed. 212/375 patients underwent reinterventions without significant differences in the mean number of secondary procedures, as previously reported (0.60, 0.61 and 0.69 reinterventions per-patient-year for sAVF, WavelinQ pAVF and Ellipsys pAVF groups, respectively (p = 0.98)). Costs per reintervention varied depending on reintervention approach and complexity between €2016 and €11,554. The projected total number of reinterventions at 5 years was somewhat higher with the pAVF modalities (1.97 and 1.94 events at 5 years with Ellipsys and WavelinQ-pAVF, respectively, compared to 1.69 events with sAVF). Projected cumulative follow-on costs were however numerically lowest for Ellipsys-pAVF (€5780), followed by sAVF (€6036) and WavelinQ-pAVF (€6711) based on the different types of reinterventions and lower rates of access abandonment.

Conclusions:

Long-term maintenance costs are substantial for both sAVFs and pAVFs and do not seem to differ materially between percutaneous and surgical AVFs, despite some observed differences in procedure complexity that might benefit percutaneous AVF. Further study and future developments in pAVF technology including a further reduced reintervention burden and lower-cost pAVF-devices are warranted to increase the application of pAVF technology in haemodialysis patients.