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Kidney Week

Abstract: SA-PO1106

Hemodialysis Costs by Vascular Access Type and Outcomes in the Incident Year

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

We profiled Medicare expenditures over time among incident hemodialysis (HD) patients in an End Stage Renal Disease Seamless Care Organization (ESCO), stratified by vascular access type. 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 identified adult HD patients in a large dialysis organization (LDO) who: 1) were treated in an ESCO clinic, 2) had Medicare as payer, 3) had arteriovenous fistula/graft (AVF/AVG) implanted ≤90 days from first date of dialysis (FDD) or exclusively had a central venous catheter (CVC) throughout follow-up. We compared average costs of care per member per month (PMPM) in AVF/AVG versus CVC patients from 90 days to 6, 9, or 12 months after FDD. We stratified those with outcomes and censored their data in subsequent periods.

Results

Patients with an AVF/AVG implanted had lower average Medicare expenditures from 90 days from FDD to the 6, 9, and 12-month follow-up compared to those treated exclusively with a CVC (Figure 1; all p<0.05). Costs did not differ in any follow-up period among AVF/AVG versus CVC patients who died, received a transplant, or transferred out of the facility. However, survival was 6, 4, and 1 percentage points higher in AVF/AVG versus CVC patients at the 6, 9, and 12-month follow-up periods, respectively.

Conclusion

Compared to incident HD patients with exclusive CVC, those with an AVF/AVG placed within 90 days of initiation had a lower cost of care over the first year of HD. Costs in those with outcomes during a follow-up period were not distinct between AVF/AVG versus CVC groups.

Funding

  • Commercial Support