Evidence map›Paper›PMID 34153489›Full record

ArticleAnnals of vascular surgery2021

Quantifying The Costs of Creating and Maintaining Hemodialysis Access in An All-Payer Rate-Controlled Health System.

Rebecca Sorber, Joseph K Canner, Christopher J Abularrage, Paula K Shireman, Dorry L Segev, James H Black Iii, Karen Woo, Caitlin W Hicks

Abstract readComparative Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Annals of vascular surgery, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed.

  1. Article
  2. Article
  3. Article
  4. Article
  5. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Rebecca SorberDivison of Vascular Surgery and Endovascular Therapy, The Johns Hopkins University School of Medicine, Baltimore MD.
Joseph K CannerJohns Hopkins Surgical Outcomes Research, The Johns Hopkins University School of Medicine, Baltimore MD.
Christopher J AbularrageDivison of Vascular Surgery and Endovascular Therapy, The Johns Hopkins University School of Medicine, Baltimore MD.
Paula K ShiremanDivision of Vascular Surgery, University of Texas Health San Antonio Long School of Medicine & the South Texas Veterans Health Care System, San Antonio, TX.
Dorry L SegevDivision of Transplant Surgery, The Johns Hopkins University School of Medicine, Baltimore MD.
James H Black IiiDivison of Vascular Surgery and Endovascular Therapy, The Johns Hopkins University School of Medicine, Baltimore MD.
Karen WooDivision of Vascular Surgery, Department of Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles CA.
Caitlin W HicksDivison of Vascular Surgery and Endovascular Therapy, The Johns Hopkins University School of Medicine, Baltimore MD.; Johns Hopkins Surgical Outcomes Research, The Johns Hopkins University School of Medicine, Baltimore MD.. Electronic address: chicks11@jhmi.edu.

Funding

Risk Factors and Outcomes Associated with Late-Life Diabetic Peripheral NeuropathyK23DK124515 · NIDDK · JOHNS HOPKINS UNIVERSITY · PI HICKS, CAITLIN WHITNEY · 2020 to 2024
$898k
NIDDK NIH HHS K23 DK124515
6 · The paper itself

Abstract

objectivesThe creation and maintenance of durable hemodialysis access is critically important for reducing patient morbidity and controlling overall costs within health systems. Our objective was to quantify the costs associated with hemodialysis access creation and its maintenance over time within a rate-controlled health system where charges equate to payments.

methodsThe Maryland Health Services Cost Review Commission administrative claims database was used to identify patients who underwent first-time access creation from 2012-2020. Patients were identified using CPT codes for access creation, and costs were accrued for the initial encounter and all subsequent outpatient access-related encounters. T-tests and Wilcoxon tests were used to compare reinterventions and access-related costs ($USD) between arteriovenous fistulae (AVF) and arteriovenous grafts (AVG). Multivariable modeling was used to quantify the association of access type with charge variation.

resultsOverall, 12,716 patients underwent first-time access creation (69.3% AVF vs. 30.7% AVG). There was no difference in freedom from reintervention between the two access types at any point following creation (HR: 1.03, 95%CI: 0.97-1.10); however, AVF were associated with a lower number of cumulative reinterventions (1.50 vs. 2.24) compared to AVG (P<0.0001). AVF was associated with lower overall costs in the year of creation ($9,388 vs. $13,539, P<0.0001), a difference that remained significant over the subsequent 3 years. The lower costs associated with AVF were present both in the costs associated with creation and subsequent maintenance. On multivariable analysis, AVF was associated with a $3,557 reduction in total access-related costs versus AVG (95%CI -$3828, -3287).

conclusionAVF require fewer interventions and are associated with lower costs at placement and over the first three years of maintenance compared to AVG. The use of AVF for first-time hemodialysis access represents an opportunity for healthcare savings in appropriately selected patients with a high preoperative likelihood of AVF maturation.

Indexed as

Health Care CostsAdministrative Claims, HealthcareAdultAgedAged, 80 and overArteriovenous Shunt, SurgicalBlood Vessel Prosthesis ImplantationCost-Benefit AnalysisCost SavingsFemaleHealth Systems PlansHumansKidney Failure, ChronicMaleMarylandMiddle Aged

Identifiers

PMID34153489
PMCPMC8595578

What OpenQuestion holds

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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.