Ocala Heart Institute, Munroe Regional Medical Center, Ocala, FL 34474, USA.
Catheter Cardiovasc Interv. 2010 Jan 1;75(1):14-21. doi: 10.1002/ccd.22247.
We sought to determine the economic value of early angiography and prophylactic angioplasty to prevent hemodialysis-access thrombosis.
End stage renal disease consumes more than 6% of the Medicare budget. There is a need to understand the financial impact of each component of care.
We conducted an observational economic analysis of a closed cohort of 818 hemodialysis patients, of whom 560 were referred for 1437 consecutive radiographic procedures during an 8-year period. Patient-level, bottom-up microcosting methods provided supply and personnel costs before and after expansion of an angiographic referral program.
The rate of referral for malfunctioning but nonthrombosed hemodialysis accesses increased from 18.8 +/- 8.8 to 48.3 +/- 11.9 angiographic procedures per 100 patient-years (P < 0.001), which was associated with a decline in access thrombosis from 27.6 to 22.0 events per 100 patient-years (P = 0.029) and a net cost of $34,586 per 100 patient-years. The incremental cost-effectiveness ratio for invasive surveillance was $6,177 per thrombosis event avoided. The angiographic program expanded at the same time that the proportion of autogenous fistulas increased from 28.3% +/- 11.3% to 59.7% +/- 10.7% of total referrals (P = 0.0001). On multivariable logistic regression analysis, the expanded angiography program (P = 0.001) and the proportion of autogenous fistulas (P = 0.0001) were both independently associated with the reduction in access thrombosis.
Given the incremental costs and the relatively modest benefits in preventing access thrombosis, preemptive angiographic management may represent a less efficient use of healthcare resources than increasing the number of patients with autogenous fistulas. (c) 2009 Wiley-Liss, Inc.
我们旨在确定早期血管造影和预防性血管成形术预防血液透析通路血栓形成的经济价值。
终末期肾病消耗了超过 6%的医疗保险预算。有必要了解护理的每个组成部分的财务影响。
我们对 818 名血液透析患者的封闭队列进行了观察性经济分析，其中 560 名患者在 8 年期间接受了 1437 项连续放射学检查。患者层面的自下而上微观成本分析提供了血管造影转诊计划扩大前后的供应和人员成本。
功能障碍但非血栓形成的血液透析通路的转诊率从 18.8 +/- 8.8 增加到 48.3 +/- 11.9 次/100 患者年（P < 0.001），这与通路血栓形成率从 27.6 降至 22.0 次/100 患者年（P = 0.029）和每年每 100 名患者净成本 34586 美元相关。侵入性监测的增量成本效益比为每避免一次血栓形成事件 6177 美元。血管造影计划扩大的同时，自体瘘的比例从 28.3% +/- 11.3%增加到 59.7% +/- 10.7%（P = 0.0001）。在多变量逻辑回归分析中，扩大的血管造影计划（P = 0.001）和自体瘘的比例（P = 0.0001）均与通路血栓形成的减少独立相关。
鉴于增量成本和预防通路血栓形成的相对适度益处，预防性血管造影管理可能代表对医疗资源的利用效率低于增加自体瘘患者的数量。（c）2009 Wiley-Liss，Inc.
