Vascular Access Outcomes: Impact on Quality of Life and Associated Costs Following Surgical or Endovascular Arteriovenous Fistula Creation for Hemodialysis Patients

Arteriovenous fistulas (AVFs) are the preferred hemodialysis vascular access (VA), but use of surgically-created AVFs (sAVFs) is hindered by maturation time, failure rates, and complications requiring interventions. The everlinQ™ endoAVF System uses an endovascular method instead of open surgery to create AVFs (endoAVF). This study compared patients with endoAVF and sAVF on VA use, quality of life, and costs. This retrospective analysis compared endoAVF patients from the Novel Endovascular Access Trial with previously-identified propensity-score matched sAVF patients from the US Renal Data System for one year after AVF creation. Exclusion criteria were: predialysis at study exit, peritoneal dialysis, kidney transplant, or unintentional endoAVF ligation. AVF creation and intervention costs were from Centers for Medicare and Medicaid Services fee schedules. Dates of dialysis initiation, AVF, arteriovenous graft, or central venous catheter (CVC) placement, and CVC removal were used to quantify days of VA use by type for each patient. Utilities for predialysis status and dialysis by VA type were assessed using published SF-36 subscale scores and a published conversion algorithm. A sub-analysis evaluated only patients on dialysis at index. Sixty sAVF and 38 endoAVF patients were included. Compared to sAVF, endoAVF patients had an average of 76 more AVF days, 92 fewer CVC days, 3.5 fewer interventions and 0.034 more quality-adjusted life-years (QALYs). Without the endoAVF device cost, average per-patient intervention cost in the first year was $11,355 lower with endoAVF vs sAVF. Results were similar among patients on dialysis at index (endoAVF n=22, sAVF n=35): $13,627 average cost-savings and 0.026 QALY increase with endoAVF. endoAVF is expected to lead to improved outcomes for hemodialysis patients and cost-savings if the endoAVF device cost is below $11,355. Compared to sAVF, endoAVF patients were more likely to be using AVF, minimize CVC use, have higher quality of life and incur lower intervention-related costs.