title: Cost-effectiveness of vascular access for haemodialysis: arteriovenous fistulas versus arteriovenous grafts.
abstract: BACKGROUND
  The use of an arteriovenous fistula (AVF) for haemodialysis treatment may be associated with a high early failure rate, but usually good long-term patency, while using an arteriovenous graft (AVG) yields a lower early failure rate with worse long-term patency. The aim of this study was to calculate and compare the costs and outcome of AVF and AVG surgery in terms of early and long-term patencies.
  
  
  METHODS
  A decision tree and a Markov model were constructed to calculate costs and performance of AVFs and AVGs. The model was populated with a retrospective cohort of HD patients receiving their first VA. The outcomes were determined probabilistically with a 5-year follow-up.
  
  
  RESULTS
  AVFs were usable for a mean (95% CI) of 28.5 months (24.6-32.5 months), while AVGs showed a patency of 25.5 months (20.0-31.2 months). The use of AVFs was the dominant type of VA and € 631 could be saved per patient/per month patency compared to AVG use. Regardless of the willingness to pay, the use of AVFs yielded a higher probability of being cost-effective compared to AVGs.
  
  
  CONCLUSIONS
  AVFs are more cost-effective than AVGs. Nonetheless, early failure rates significantly influence AVF performance and initiatives to reduce early failure can improve its cost-effectiveness.
authors.affiliation: Department of Surgery, Maastricht University Medical Center (MUMC), P. Debyelaan 25, 6202 AZ Maastricht, The Netherlands.
authors.forename: J J P M
authors.initials: JJ
authors.lastname: Leermakers
authors.forename: A S
authors.initials: AS
authors.lastname: Bode
authors.forename: A
authors.initials: A
authors.lastname: Vaidya
authors.forename: F M
authors.initials: FM
authors.lastname: van der Sande
authors.forename: S M A A
authors.initials: SM
authors.lastname: Evers
authors.forename: J H M
authors.initials: JH
authors.lastname: Tordoir
mesh_terms: D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects / Q000191:economics*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000191:economics*; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D003663:Decision Trees; D006083:Graft Occlusion, Vascular / Q000191:economics / Q000209:etiology / Q000628:therapy; D017048:Health Care Costs; D006801:Humans; D007676:Kidney Failure, Chronic / Q000191:economics / Q000628:therapy*; D008390:Markov Chains; D018803:Models, Economic; D011183:Postoperative Complications / Q000191:economics / Q000628:therapy; D006435:Renal Dialysis / Q000191:economics*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency