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Endovascular versus surgical creation of arteriovenous fistula in hemodialysis patients: Cost-effectiveness and budget impact analyses.

血液透析患者动静脉内瘘的血管内与外科手术: 成本效益和预算影响分析。

  • 影响因子:1.12
  • DOI:10.1177/1129729820921021
  • 作者列表:"Rognoni C","Tozzi M","Tarricone R
  • 发表时间:2021-01-01
Abstract

OBJECTIVES:The aim of the present study was to perform cost-effectiveness and budget impact analyses comparing endovascular arteriovenous fistula creation to surgical arteriovenous fistula creation in hemodialysis patients from the National Healthcare Service (NHS) perspective in Italy. METHODS:A systematic literature review has been conducted to retrieve complications' rates after arteriovenous fistula creation procedures. One study comparing endovascular arteriovenous fistula creation, performed with WavelinQ device, to the surgical approach through propensity score matching was preferred to single-arm investigations to execute the economic evaluations. This study was chosen to populate a Markov model to project, on a time horizon of 1 year, quality adjusted life years and costs associated with endovascular arteriovenous fistula (WavelinQ) and surgical arteriovenous fistula options for both cohorts of incident and prevalent hemodialysis patients. RESULTS:For both incident and prevalent hemodialysis patients, endovascular arteriovenous fistula creation, performed with WavelinQ, was the dominant strategy over surgical arteriovenous fistula approach, showing less cost and better patients' quality of life. Compared to the current scenario, progressively increasing utilization rates of WavelinQ over surgical arteriovenous fistula creation in the next 5 years in incident hemodialysis patients are expected to save globally 30-36 million euros to the NHS. CONCLUSION:Endovascular arteriovenous fistula creation performed with WavelinQ could be a cost-saving strategy in comparison with the surgical approach for patients in hemodialysis. Future studies comparing different devices for endovascular arteriovenous fistula creation versus the surgical option would be needed to confirm or reject the validity of this preliminary evaluation. In the meantime, decision-makers can use these results to take decisions on the diffusion of endovascular procedures in Italy.

摘要

目的: 本研究的目的是从意大利国家医疗保健服务 (NHS) 的角度对血液透析患者进行成本效益和预算影响分析,比较血管内动静脉内瘘创建与外科动静脉内瘘创建。 方法: 进行了系统的文献回顾,以检索动静脉内瘘创建程序后的并发症率。一项通过倾向评分匹配比较血管内动静脉内瘘创建 (使用WavelinQ装置) 与手术入路的研究优于单臂研究,以执行经济评估。选择本研究填充Markov模型,在1年的时间范围内预测与血管内动静脉内瘘 (WavelinQ) 和外科动静脉内瘘选项相关的质量调整生命年以及成本,用于事件和普遍血液透析患者队列。 结果: 对于偶发和普遍的血液透析患者,使用WavelinQ进行的血管内动静脉内瘘创建是手术动静脉内瘘方法的主导策略,显示出更低的成本和更好的患者生活质量。与目前的情况相比,在未来5年内,在发生血液透析的患者中,与手术动静脉内瘘相比,逐渐增加的WavelinQ使用率预计将为NHS节省全球3000-3600万欧元。 结论: 与血液透析患者的手术方式相比,使用WavelinQ建立血管内动静脉内瘘可能是一种节约成本的策略。未来的研究需要比较不同的血管内动静脉瘘建立装置与手术选择,以确认或拒绝这一初步评估的有效性。与此同时,决策者可以利用这些结果对意大利血管内手术的扩散做出决定。

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