Pcv29 Cost-Effectiveness of Coronary and Peripheral Artery Disease Treatments

Abstract

Objectives: Arteriovenous fistulas (AVF) are associated with lower morbidity and higher patency compared with other methods of hemodialysis (HD) vascular access. However, surgical fistula creation has important limitations including high failure rates and associated costs. This economic analysis examined the introduction of a less invasive, endovascular AVF creation option with the WavelinQ endoAVF System. Methods: A 1-year model was developed based on event rates from propensityscore matched analyses and observational data for HD vascular access procedures. From the payer perspective, the model compared the budget impact of a central venous catheter (CVC) and surgical AVF landscape to a treatment combination of CVC, surgical AVF, and WavelinQ. Procedure distribution and payment rates for index procedures and subsequent interventions (e.g., infection treatment, catheter placement, new AVF) were based on U.S. Medicare averages. From an outpatient provider perspective, costs rather than payments, were the unit of analysis. In addition to subsequent interventions, operating room location and time costs were assessed for providers. Results: Assuming a payer health plan size of 1 million patients, the model predicted cost savings with the introduction of WavelinQ of $3.6 million ($5,959 per patient) over 1 year. These cost savings were attributed to less subsequent interventions with WavelinQ (i.e., reduced by 0.92 per patient). From a provider perspective, the upfront cost of the WavelinQ procedure was predicted to be offset by avoided direct resources that may likely impact a provider's bottom line. This includes use of the angiography suite rather than operating room (i.e., $2,093 avoided per patient) and less infection-related costs (i.e., $5,355 avoided per patient) with WavelinQ. Conclusions: Use of an endovascular option for AVF access was associated with important cost savings for both the payer and provider compared with current HD access methods. Future study should examine longer term economic benefits of this new procedure.