title: Cost-effectiveness of antiplatelet therapy to prolong primary patency of hemodialysis graft.
abstract: BACKGROUND
  The Dialysis Access Consortium (DAC) study group previously reported that treatment with extended-release dipyridamole plus aspirin (DASA) resulted in a significant but clinically modest improvement in primary unassisted arteriovenous graft (AVG) patency. Utilizing DAC published data, the objective of this study is to evaluate the cost effectiveness of antiplatelet interventions aimed at preventing loss of primary AVG patency in hemodialysis (HD) patients.
  
  
  METHODS
  We performed a cost-utility analysis, using a decision analysis tree model with a 12-month time horizon and a third party payer perspective. Interventions included DASA with and without concurrent aspirin, aspirin alone, and no prophylaxis. The modeled population was defined as adult (≥ 18 years of age) end-stage renal disease (ESRD) patients who had undergone placement of a new AVG in the United States. The outcomes were costs, quality-adjusted life-years (QALY), incremental cost-effectiveness ratios, and net monetary benefit. Probabilities were based upon published studies performed by the DAC Study Group while costs of medications and procedures were drawn from public sources. Utilities of health states were derived from published reports and the Short Form 6D (SF-6D) instrument.
  
  
  RESULTS
  Aspirin alone is the most cost effective strategy for AVG pharmacologic prophylaxis, as compared to no prophylaxis or DASA with or without concurrent aspirin. The results are robust on multiple scenario analyses using both deterministic and Monte Carlo probabilistic sensitivity analyses. Accounting for both costs and QALY, using aspirin alone to prevent AVG thrombosis can potentially reduce healthcare costs by $24,679,412 per year compared to no aspirin use, at a willingness-to-pay of $50,000/ QALY.
  
  
  CONCLUSIONS
  Aspirin monotherapy compared favorably to other strategies based on cost per QALY. Our findings support the use of aspirin prophylaxis in HD patients with a new AVG who do not have a contraindication to aspirin.
authors.forename: Robert
authors.initials: R
authors.lastname: Nee
authors.forename: Austin L
authors.initials: AL
authors.lastname: Parker
authors.forename: Dustin J
authors.initials: DJ
authors.lastname: Little
authors.forename: Christina M
authors.initials: CM
authors.lastname: Yuan
authors.forename: Jonathan
authors.initials: J
authors.lastname: Himmelfarb
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Lowe
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Abbott
mesh_terms: D000328:Adult; D001166:Arteriovenous Shunt, Surgical; D001241:Aspirin / Q000627:therapeutic use; D000068342:Aspirin, Dipyridamole Drug Combination; D003362:Cost-Benefit Analysis; D004176:Dipyridamole / Q000627:therapeutic use; D004311:Double-Blind Method; D004338:Drug Combinations; D006083:Graft Occlusion, Vascular / Q000517:prevention & control*; D006801:Humans; D009010:Monte Carlo Method; D010975:Platelet Aggregation Inhibitors / Q000191:economics / Q000627:therapeutic use*; D019057:Quality-Adjusted Life Years; D006435:Renal Dialysis / Q000009:adverse effects / Q000191:economics
chemical_list: D000068342:Aspirin, Dipyridamole Drug Combination; D004338:Drug Combinations; D010975:Platelet Aggregation Inhibitors; D004176:Dipyridamole; D001241:Aspirin