Abstract: SA-PO1087
Costs of Hemodialysis in Survivors During the Incident Year by Vascular Access Type
Session Information
- Vascular Access - II
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 704 Dialysis: Vascular Access
Authors
- Willetts, Joanna, Fresenius Medical Care North America, Waltham, Massachusetts, United States
- Chaudhuri, Sheetal, Fresenius Medical Care North America, Waltham, Massachusetts, United States
- Radonova, Maria, Fresenius Medical Care North America, Waltham, Massachusetts, United States
- Weinhandl, Eric D., Fresenius Medical Care North America, Waltham, Massachusetts, United States
- Larkin, John W., Fresenius Medical Care North America, Waltham, Massachusetts, United States
- Usvyat, Len A., Fresenius Medical Care North America, Waltham, Massachusetts, United States
- Ketchersid, Terry L., Fresenius Medical Care North America, Waltham, Massachusetts, United States
- Maddux, Franklin W., Fresenius Medical Care, Waltham, Massachusetts, United States
Background
Estimated cost of care of hemodialysis (HD) access types vary and infrequently account for survival. We identified benchmarks for Medicare expenditures in patients in an End Stage Renal Disease Seamless Care Organization (ESCO) who had an arteriovenous fistula/graft (AVF/AVG) implanted, or had only a central venous catheter (CVC), and survived various follow-up periods. The statements contained in this document are solely those of the authors and do not necessarily reflect the views or policies of the Centers for Medicare & Medicaid Services (CMS). The authors assume responsibility for the accuracy and completeness of the information contained in this document.
Methods
We used data from adults at a large dialysis organization (LDO) who: 1) had Medicare as payor, 2) were treated at an ESCO by HD, 2) had an AVF/AVG implanted ≤90 days from first date of dialysis (FDD) or exclusively had a CVC, and 3) survived a 6, 9, or 12-month follow-up from FDD. We compared mean Medicare expenditures per member per month (PMPM) in AVF/AVG versus CVC patients who survived each follow-up period, as well as the entire incident year.
Results
Survivors with an AVF/AVG implanted ≤90 days of FDD had a lower Medicare expenditures PMPM from 90 days after FDD to the 6-month (AVF/AVG=$7,157±6,457 [n=1566]; CVC=$8,290±8,585 [n=723]; p<0.001), 9-month (AVF/AVG=$6,636±4,919 [n=1211]; CVC=$7,539±6,917 [n=483]; p<0.01), and 12-month (AVF/AVG=$6,424±4,333 [n=839]; CVC=$7,133±6,379 [n=309]; p=0.03) follow-up, as compared to CVC patients. Among survivors of the entire incident year, AVF/AVG patients consistently had a lower cost at the 9- and 12-month follow-up (both p<0.05) versus CVC patients, yet only favorable trends were seen at the 6-month follow-up (p<0.19).
Conclusion
Implantation of an AVF/AVG in the first 90 days of HD was associated with lower costs during the incident year of HD compared to CVC patients without a permanent access placed. Findings represent a sub-group who survived each defined period, or the overall incident year, yielding unadjusted comparisons with equivalent exposure times between access types. However, distinctions in survival between AVF/AVG versus CVC patients should be considered.
Funding
- Commercial Support –