Medicare Costs Associated With Arteriovenous Fistulas Among US Hemodialysis Patients
Medicare Costs Associated With Arteriovenous Fistulas Among US Hemodialysis Patients
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DOI：
10.1053/j.ajkd.2018.01.034
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发表时间：
2018-07-01
影响因子：
13.2
通讯作者：
Pflederer, Timothy A.
中科院分区：
文献类型：
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作者：
Thamer, Mae;Lee, Timmy C.;Pflederer, Timothy A.
背景：动静脉瘘（AVF）是推荐的血液透析（HD）血管通路。以前的研究没有检查与创建和维护avf相关的资源和成本。研究设计：回顾性观察性研究。背景和参与者：2010 - 2011年美国老年医保患者开始血液透析治疗。预测指标：AVF原发性和继发性通畅，并在AVF产生后的第一年不使用。结果：每位患者每年的血管通路费用。结果：在HD治疗开始时仅使用导管的患者中，只有54%的avf成功用于HD， 10%的使用但在创建后1年内出现继发性通畅丧失，83%的患者在创建后1年内出现原发性通畅丧失。在AVF创建后的2.5年里，每位患者每年的平均血管通路费用为：第一年保持原发性通畅的AVF为7871美元，第一年出现原发性通畅的AVF为13282美元，第一年出现继发性通畅的AVF为17808美元，未使用AVF的为31630美元。在HD治疗开始时AVF成熟的患者和HD治疗开始时导管和AVF成熟的患者中也发现了类似的模式。总体而言，2013年，按服务收费的医疗保险为透析血管相关服务支付了28亿美元，相当于所有终末期肾病支付的12%。限制：缺乏特定计费代码的粒度。结论：AVF失败在创建后的第一年是常见的，并导致大量较高的医疗费用。与avf维持原发通畅的患者相比，avf发生原发或继发通畅丧失的患者血管通路成本高出2至3倍，而从未使用过avf的患者血管通路成本高出4倍。有必要改善AVF的结果，并降低AVF创建后的成本。
Background: An arteriovenous fistula (AVF) is the recommended vascular access for hemodialysis (HD). Previous studies have not examined the resources and costs associated with creating and maintaining AVFs.Study Design: Retrospective observational study.Setting & Participants: Elderly US Medicare patients initiating hemodialysis therapy during 2010 to 2011. Predictor: AVF primary and secondary patency and nonuse in the first year following AVF creation. Outcomes: Annualized vascular access costs per patient per year.Results: Among patients with only a catheter at HD therapy initiation, only 54% of AVFs were successfully used for HD, 10% were used but experienced secondary patency loss within 1 year of creation, and 83% experienced primary patency loss within 1 year of creation. Mean vascular access costs per patient per year in the 2.5 years after AVF creation were $7,871 for AVFs that maintained primary patency in year 1, $13,282 for AVFs that experienced primary patency loss in year 1, $17,808 for AVFs that experienced secondary patency loss in year 1, and $31,630 for AVFs that were not used. Similar patterns were seen among patients with a mature AVF at HD therapy initiation and patients with a catheter and maturing AVF at HD therapy initiation. Overall, in 2013, fee-forservice Medicare paid $2.8 billion for dialysis vascular access-related services, similar to 12% of all end-stage renal disease payments.Limitations: Lack of granularity with certain billing codes.Conclusions: AVF failure in the first year after creation is common and results in substantially higher health care costs. Compared with patients whose AVFs maintained primary patency, vascular access costs were 2 to 3 times higher for patients whose AVFs experienced primary or secondary patency loss and 4 times higher for patients who never used their AVFs. There is a need to improve AVF outcomes and reduce costs after AVF creation.