Skip to main content

Choice of Hemodialysis Access in Older Adults: A Cost-Effectiveness Analysis.

Publication ,  Journal Article
Hall, RK; Myers, ER; Rosas, SE; O'Hare, AM; Colón-Emeric, CS
Published in: Clin J Am Soc Nephrol
June 7, 2017

BACKGROUND AND OBJECTIVES: Although arteriovenous fistulas have been found to be the most cost-effective form of hemodialysis access, the relative benefits of placing an arteriovenous fistula versus an arteriovenous graft seem to be least certain for older adults and when placed preemptively. However, older adults' life expectancy is heterogeneous, and most patients do not undergo permanent access creation until after dialysis initiation. We evaluated cost-effectiveness of arteriovenous fistula placement after dialysis initiation in older adults as a function of age and life expectancy. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Using a hypothetical cohort of patients on incident hemodialysis with central venous catheters, we constructed Markov models of three treatment options: (1) arteriovenous fistula placement, (2) arteriovenous graft placement, or (3) continued catheter use. Costs, utilities, and transitional probabilities were derived from existing literature. Probabilistic sensitivity analyses were performed by age group (65-69, 70-74, 75-79, 80-84, and 85-89 years old) and quartile of life expectancy. Costs, quality-adjusted life-months, and incremental cost-effectiveness ratios were evaluated for up to 5 years. RESULTS: The arteriovenous fistula option was cost effective compared with continued catheter use for all age and life expectancy groups, except for 85-89 year olds in the lowest life expectancy quartile. The arteriovenous fistula option was more cost effective than the arteriovenous graft option for all quartiles of life expectancy among the 65- to 69-year-old age group. For older age groups, differences in cost-effectiveness between the strategies were attenuated, and the arteriovenous fistula option tended to only be cost effective in patients with life expectancy >2 years. For groups for which the arteriovenous fistula option was not cost saving, the cost to gain one quality-adjusted life-month ranged from $2294 to $14,042. CONCLUSIONS: Among older adults, the cost-effectiveness of an arteriovenous fistula placed within the first month of dialysis diminishes with increasing age and lower life expectancy and is not the most cost-effective option for those with the most limited life expectancy.

Duke Scholars

Altmetric Attention Stats
Dimensions Citation Stats

Published In

Clin J Am Soc Nephrol

DOI

EISSN

1555-905X

Publication Date

June 7, 2017

Volume

12

Issue

6

Start / End Page

947 / 954

Location

United States

Related Subject Headings

  • Urology & Nephrology
  • Treatment Outcome
  • Time Factors
  • Renal Dialysis
  • Quality-Adjusted Life Years
  • Patient Selection
  • Monte Carlo Method
  • Models, Economic
  • Markov Chains
  • Life Expectancy
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Hall, R. K., Myers, E. R., Rosas, S. E., O’Hare, A. M., & Colón-Emeric, C. S. (2017). Choice of Hemodialysis Access in Older Adults: A Cost-Effectiveness Analysis. Clin J Am Soc Nephrol, 12(6), 947–954. https://doi.org/10.2215/CJN.11631116
Hall, Rasheeda K., Evan R. Myers, Sylvia E. Rosas, Ann M. O’Hare, and Cathleen S. Colón-Emeric. “Choice of Hemodialysis Access in Older Adults: A Cost-Effectiveness Analysis.Clin J Am Soc Nephrol 12, no. 6 (June 7, 2017): 947–54. https://doi.org/10.2215/CJN.11631116.
Hall RK, Myers ER, Rosas SE, O’Hare AM, Colón-Emeric CS. Choice of Hemodialysis Access in Older Adults: A Cost-Effectiveness Analysis. Clin J Am Soc Nephrol. 2017 Jun 7;12(6):947–54.
Hall, Rasheeda K., et al. “Choice of Hemodialysis Access in Older Adults: A Cost-Effectiveness Analysis.Clin J Am Soc Nephrol, vol. 12, no. 6, June 2017, pp. 947–54. Pubmed, doi:10.2215/CJN.11631116.
Hall RK, Myers ER, Rosas SE, O’Hare AM, Colón-Emeric CS. Choice of Hemodialysis Access in Older Adults: A Cost-Effectiveness Analysis. Clin J Am Soc Nephrol. 2017 Jun 7;12(6):947–954.

Published In

Clin J Am Soc Nephrol

DOI

EISSN

1555-905X

Publication Date

June 7, 2017

Volume

12

Issue

6

Start / End Page

947 / 954

Location

United States

Related Subject Headings

  • Urology & Nephrology
  • Treatment Outcome
  • Time Factors
  • Renal Dialysis
  • Quality-Adjusted Life Years
  • Patient Selection
  • Monte Carlo Method
  • Models, Economic
  • Markov Chains
  • Life Expectancy