title: Cost analysis of the Hemodialysis Reliable Outflow (HeRO) Graft compared to the tunneled dialysis catheter.
abstract: BACKGROUND
  In end-stage renal disease patients with central venous obstruction, who have limited vascular access options, the Hemodialysis Reliable Outflow (HeRO) Graft is a new alternative with a lower incidence of complications and longer effective device life compared to tunneled dialysis catheters (TDCs). We undertook an economic analysis of introducing the HeRO Graft in the UK.
  
  
  METHODS
  A 1-year cost-consequence decision analytic model was developed comparing management with the HeRO Graft to TDCs from the perspective of the National Health Service in England. The model comprises four 3-month cycles during which the vascular access option either remains functional for hemodialysis or fails, patients can experience access-related infection and device thrombosis, and they can also accrue associated costs. Clinical input data were sourced from published studies and unit cost data from National Health Service 2014-15 Reference Costs.
  
  
  RESULTS
  In the base case, a 100-patient cohort managed with the HeRO Graft experienced 6 fewer failed devices, 53 fewer access-related infections, and 67 fewer device thromboses compared to patients managed with TDCs. Although the initial device and placement costs for the HeRO Graft are greater than those for TDCs, savings from the lower incidence of device complications and longer effective device patency reduces these costs. Overall net annual costs are £2600 for each HeRO Graft-managed patient compared to TDC-managed patients. If the National Health Service were to reimburse hemodialysis at a uniform rate regardless of the type of vascular access, net 1-year savings of £1200 per patient are estimated for individuals managed with the HeRO Graft.
  
  
  CONCLUSIONS
  The base case results showed a marginal net positive cost associated with vascular access with the HeRO Graft compared with TDCs for the incremental clinical benefit of reductions in patency failures, device-related thrombosis, and access-related infection events in a patient population with limited options for dialysis vascular access.
authors.affiliation: Department of Renal Surgery, QEHB, University Hospital Birmingham, Birmingham, United Kingdom. Electronic address: j.alshakarchi@nhs.net.
authors.forename: Julien
authors.initials: J
authors.lastname: Al Shakarchi
authors.affiliation: Department of Renal Surgery, QEHB, University Hospital Birmingham, Birmingham, United Kingdom.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Inston
authors.affiliation: Department of Radiology, QEHB, University Hospital Birmingham, Birmingham, United Kingdom.
authors.forename: Robert G
authors.initials: RG
authors.lastname: Jones
authors.affiliation: Health Economics & Outcomes Research Consultant, London, United Kingdom.
authors.forename: Grant
authors.initials: G
authors.lastname: Maclaine
authors.affiliation: CryoLife Europa Ltd, Guildford, Surrey, United Kingdom.
authors.forename: David
authors.initials: D
authors.lastname: Hollinworth
mesh_terms: D001807:Blood Vessel Prosthesis / Q000009:adverse effects / Q000191:economics*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000191:economics* / Q000295:instrumentation; D061807:Catheter Obstruction / Q000191:economics / Q000209:etiology; D055499:Catheter-Related Infections / Q000191:economics / Q000382:microbiology / Q000628:therapy; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000191:economics* / Q000295:instrumentation; D002408:Catheters, Indwelling / Q000009:adverse effects / Q000191:economics*; D062905:Central Venous Catheters; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D004739:England; D006083:Graft Occlusion, Vascular / Q000191:economics / Q000209:etiology / Q000628:therapy; D017048:Health Care Costs; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000191:economics* / Q000628:therapy*; D018803:Models, Economic; D011474:Prosthesis Design; D011475:Prosthesis Failure; D016459:Prosthesis-Related Infections / Q000191:economics / Q000382:microbiology / Q000628:therapy; D006435:Renal Dialysis / Q000191:economics*; D013222:State Medicine / Q000191:economics; D013927:Thrombosis / Q000191:economics / Q000209:etiology / Q000628:therapy; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency