Cost Analysis of the Creation and Maintenance of Functional Arteriovenous Grafts for Hemodialysis
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1 Cost Analysis of the Creation and Maintenance of Functional Arteriovenous Grafts for Hemodialysis Neeraja Konuthula BS, Steven D. Abramowitz MD, Harry Schanzer MD, Peter L. Faries MD, Michael L. Marin MD, Victoria J. Teodorescu MD MBA
2 Disclosures Neeraja Konuthula, BS: Nothing to Disclose Steven Abramowitz, MD: Nothing to Disclose Harry Schanzer, MD: W.L. Gore & Associates Peter Faries, MD: Nothing to Disclose Michael Marin, MD: Nothing to Disclose Victoria Teodorescu, MD: W.L. Gore & Associates
3 AVG Cost Analysis Per 2013 USRDS (2011 data): $49.3 billion dollars were spent on total ESRD patient care $87,746 per year per HD patient $34.3 billion dollars by Medicare (7.2% of total spending) Access creation and maintenance contributes to these costs, but it is difficult to determine how.
4 Per person per month (PPPM) expenditures during the transition to ESRD, by dataset, 2011 Figure 7.19 (Volume 1) Incident Medicare (age 67 & older) & Truven Health MarketScan (younger than 65) ESRD patients, initiating in 2008.
5 Per person per month (PPPM) expenditures for vascular access during the transition to ESRD, by dataset, 2011 Figure 7.25 (Volume 1) General Medicare patients with CKD age 65 & older, & Pre-ESRD patients age 67 or older at initiation of ESRD.
6 AVG Cost Analysis Access costs with HD initiation due to catheters USRDS 2013 ADR A small percent of patients receive AVGs and costs are related to creation and the interventions required to maintain patency
7 AVG Cost Analysis Lok and Foley, 2013: Procedures for AVGs have increased twoto-three-fold over the past decade Limited data showing the procedure-related cost of graft creation and maintenance
8 AVG Cost Analysis Objective:To capture the total patient cost per year of maintaining arteriovenous graft functional patency
9 Methods Prospectively maintained database of all dialysis access procedures performed at MS since 2004 We have previously evaluated 271 AVGs placed as the first surgical access between 3/31/2007 and 1/1/2012. Variable Location Mean Functional Patency (days) Upper arm: 1,324.6±63.9 Forearm: 1,152.8±121.1
10 Methods Inclusion Criteria for this study From this group, cost analysis was performed in 218 patients with 2 years of documented functional patency Included Costs Central Venous Cather Events Access-Related Non-Invasive Diagnostic Imaging Access-Related Procedures
11 Methods Cost Analysis 1 st and 2 nd Year Events Coding Current Procedural (CPT) Healthcare Common Procedure Coding System (HCPCS) Patient Classification Outpatient: Ambulatory Payment Classification (APC) Inpatient: Diagnosis Related Group (DRG) Relative Value Unit 2013 = $ (Standard MC) No Modifiers or DRG Adjustments
12 Methods Introduction
13 Results: Demographics Total Cohort Percentage Average Age (yr) Male (#pts) % Female (#pts) % DM (#pts) % HTN (#pts) % Boston Scientific (#grafts) % Gore (# grafts) % Upper Arm (# grafts) % Forearm Looped (#grafts) %
14 Results $30,000 $25,000 $20,000 $15,000 $10,000 Year 1 Year 2 $5,000 $0 CVC Imaging Procedures Total Cost CVC Imaging Procedures Total Year 1 $2,471 $508 $5,737 $12,685 Year 2 $1,784 $980 $21,123 $24,887
15 $50000 $
16 $ $
17 Conclusion Cost of AVG access and maintenance is not completely captured by USRDS cost analysis Average cost to maintain functional patency of AVG over two years increases from Year 1 to Year 2 As more hospitals turn to Accountable Care Organizations (ACOs) and a fee-per-capita systems, it becomes important to understand long term costs of procedures for chronic diseases, such as ESRD Understanding which patient populations incur greatest costs could further enhance vascular access decision making
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