title: Comparison of post-creation procedures and costs between surgical and an endovascular approach to arteriovenous fistula creation.
abstract: BACKGROUND
  Due to early and late failures that may occur with surgically created hemodialysis arteriovenous fistulas (SAVF), post-creation procedures are commonly required to facilitate AVF maturation and maintain patency. This study compared AVF post-creation procedures and their associated costs in patients with SAVF to patients with a new endovascularly created AVF (endoAVF).
  
  
  METHODS
  A 5% random sample from Medicare Standard Analytical Files was abstracted to determine post-creation procedures and associated costs for SAVF created from 2011 to 2013. Medicare enrollment during the 6 months prior to and after the AVF creation was required. Patients' follow-up inpatient, outpatient, and physician claims were used to identify post-creation procedures and to estimate average procedure costs. Comparative procedural information on endoAVF was obtained from the Novel Endovascular Access Trial (NEAT).
  
  
  RESULTS
  Of 3764 Medicare SAVF patients, 60 successfully matched to endoAVF patients using 1:1 propensity score matching of baseline demographic and clinical characteristics. The total post-creation procedural event rate within 1 year was lower for endoAVF patients (0.59 per patient-year) compared to the matched SAVF cohort (3.43 per patient-year; p<0.05). In the endoAVF cohort, event rates of angioplasty, thrombectomy, revision, catheter placement, subsequent arteriovenous graft (AVG), new SAVF, and vascular access-related infection were all significantly lower than in the SAVF cohort. The average first year cost per patient-year associated with post-creation procedures was estimated at US$11,240 USD lower for endoAVF than for SAVF.
  
  
  CONCLUSIONS
  Compared to patients with SAVF, patients with endoAVF required fewer post-creation procedures and had lower associated mean costs within the first year.
authors.affiliation:  Quorum Consulting, San Francisco, California - USA.
authors.forename: Shuo
authors.initials: S
authors.lastname: Yang
authors.affiliation:  University Health Network, University of Toronto, Toronto - Canada.
authors.forename: Charmaine
authors.initials: C
authors.lastname: Lok
authors.affiliation:  Quorum Consulting, San Francisco, California - USA.| Icahn School of Medicine, Mt Sinai Hospital, New York, NY - USA.
authors.forename: Renee
authors.initials: R
authors.lastname: Arnold
authors.affiliation:  University Health Network, University of Toronto, Toronto - Canada.
authors.forename: Dheeraj
authors.initials: D
authors.lastname: Rajan
authors.affiliation:  Eastern Virginia Medical School, Norfolk, Virginia - USA.
authors.forename: Marc
authors.initials: M
authors.lastname: Glickman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects / Q000191:economics* / Q000379:methods; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D057510:Endovascular Procedures / Q000009:adverse effects / Q000191:economics*; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D006278:Medicare / Q000191:economics; D008875:Middle Aged; D018803:Models, Economic; D011183:Postoperative Complications / Q000191:economics / Q000209:etiology / Q000628:therapy; D017064:Process Assessment, Health Care / Q000191:economics*; D057216:Propensity Score; D006435:Renal Dialysis / Q000191:economics*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States