A cost-effectiveness analysis of the introduction of a specialised consultation with duplex ultrasound assessment prior to vascular access surgery for haemodialysis

• Published in: Nefrología
• Main Authors: Mateos Torres, Eduardo, Collado Nieto, Silvia, Arenas Jimenez, Maria Dolores, Lacambra Peñart, Mónica, Marcos Garcia, Lidia, Clará Velasco, Albert
• Format: Journal Article
• Language: English; Spanish
• Published: Spain 01.01.2022
• Subjects: Fístula arteriovenosa; Arteriovenous fistula; Ecografía doppler preoperatoria; Vascular access; Cost effectiveness; Preoperative doppler ultrasound; Hemodiálisis; Haemodialysis; Coste/efectividad; Acceso vascular
• ISSN: 2013-2514
• DOI: 10.1016/j.nefro.2020.12.016

Duplex ultrasound (DUS) is increasingly used before vascular access (VA) surgery for haemodialysis. However, the cost-effectiveness of this approach is unknown. Our objective was to assess whether the introduction of a specialised consultation with DUS assessment modifies the cost and the time delay to achieve a first VA valid for haemodialysis. Prospective cohort of patients undergoing a first VA (June 2014-July 2017) after a specialised consultation with DUS (ECO group). They were compared with a historical cohort (January 2012-May 2014) where VA was indicated exclusively by clinical evaluation (CLN group). We analysed the cost related to visits, DUS assessments, interventions, hospital admissions and graft materials to achieve a first VA valid for haemodialysis at least during 1 month. Eighty-six patients in the CLN group were compared with 92 in the ECO group. Patients in the ECO group were younger (68.4 vs. 64.0 years; P=.038) but no other differences were seen among groups. The average cost to achieve a first AV valid for haemodialysis was significantly lower in the ECO group (2707 vs. 3347€; P=.024). There was a higher cost associated with DUS assessments in the ECO group yet the CLN group had a higher cost related to follow-up visits, successive surgical interventions, prosthetic material, days of hospital admission and catheters. The mean time needed to achieve a first AV valid for haemodialysis was also shorter in the ECO group (49.9 vs. 82.9 days, P=.002). The introduction of a specialised vascular access consultation with DUS prior to VA surgery has reduced the cost necessary to achieve a first VA valid for haemodialysis. From the patient's point of view this has meant less interventions and hospital admissions and a shortening of the time delay.