title: Are early cannulation arteriovenous grafts (ecAVG) a viable alternative to tunnelled central venous catheters (TCVCs)? An observational "virtual study" and budget impact analysis.
abstract: BACKGROUND
  Early cannulation arteriovenous grafts (ecAVGs) are advocated as an alternative to tunnelled central venous catheters (TCVCs). A real-time observational "virtual study" and budget impact model was performed to evaluate a strategy of ecAVG as a replacement to TCVC as a bridge to definitive access creation.
  
  
  METHODS
  Data on complications and access-related bed days was collected prospectively for all TCVCs inserted over a six-month period (n = 101). The feasibility and acceptability of an alternative strategy (ecAVGs) was also evaluated. A budget impact model comparing the two strategies was performed. Autologous access in the form of native fistula was the goal wherever possible.
  
  
  RESULTS
  We found 34.7% (n = 35) of TCVCs developed significant complications (including 17 culture-proven bacteraemia and one death from line sepsis). Patients spent an average of 11.9 days/patient/year in hospital as a result of access-related complications. The wait for TCVC insertion delayed discharge in 35 patients (median: 6 days). The ecAVGs were a practical and acceptable alternative to TCVCs in over 80% of patients. Over a 6-month period, total treatment costs per patient wereGBP5882 in the TCVC strategy and GBP4954 in the ecAVG strategy, delivering potential savings ofGBP927 per patient. The ecAVGs had higher procedure and re-intervention costs (GBP3014 vs. GBP1836); however, these were offset by significant reductions in septicaemia treatment costs (GBP1322 vs. GBP2176) and in-patient waiting time bed costs (GBP619 vs. GBP1870).
  
  
  CONCLUSIONS
  Adopting ecAVGs as an alternative to TCVCs in patients requiring immediate access for haemodialysis may provide better individual patient care and deliver cost savings to the hospital.
authors.affiliation: Department of Renal Surgery, Queen Elizabeth University Hospital, Glasgow - UK.
authors.forename: Emma
authors.initials: E
authors.lastname: Aitken
authors.affiliation: Health Economist, W.L. Gore Associates - UK.
authors.forename: Kashfa
authors.initials: K
authors.lastname: Iqbal
authors.affiliation: Department of Nephrology, Queen Elizabeth University Hospital, Glasgow - UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Thomson
authors.affiliation: Department of Interventional Radiology, Queen Elizabeth University Hospital, Glasgow - UK.
authors.forename: Ram
authors.initials: R
authors.lastname: Kasthuri
authors.affiliation: Department of Renal Surgery, Queen Elizabeth University Hospital, Glasgow - UK.
authors.forename: David
authors.initials: D
authors.lastname: Kingsmore
mesh_terms: D000368:Aged; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects / Q000191:economics* / Q000295:instrumentation; D001807:Blood Vessel Prosthesis / Q000191:economics*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000191:economics* / Q000295:instrumentation; D002017:Budgets; D055499:Catheter-Related Infections / Q000191:economics / Q000382:microbiology / Q000628:therapy; D002404:Catheterization / Q000191:economics*; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000191:economics* / Q000295:instrumentation; D002408:Catheters, Indwelling / Q000191:economics*; D062905:Central Venous Catheters / Q000191:economics*; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D005240:Feasibility Studies; D005260:Female; D006302:Health Services Research; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D011446:Prospective Studies; D006435:Renal Dialysis / Q000191:economics*; D019233:Retreatment / Q000191:economics; D013997:Time Factors; D016896:Treatment Outcome