A cost-effectiveness analysis of the introduction of a specialised consultation with duplex ultrasound assessment prior to vascular access surgery for haemodialysis
Introduction: Duplex ultrasound (DUS) is increasingly used before vascular access (VA) surgery for haemodialysis. However, the cost-effectiveness of this approach is unknown. Our objective was to assess whether the introduction of a specialised consultation with DUS assessment modifies the cost and...
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| Format: | Article |
| Language: | English |
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Elsevier
2022-01-01
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| Series: | Nefrología (English Edition) |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2013251422000153 |
| _version_ | 1817992796377710592 |
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| author | Eduardo Mateos Torres Silvia Collado Nieto Maria Dolores Arenas Jimenez Mónica Lacambra Peñart Lidia Marcos Garcia Albert Clará Velasco |
| author_facet | Eduardo Mateos Torres Silvia Collado Nieto Maria Dolores Arenas Jimenez Mónica Lacambra Peñart Lidia Marcos Garcia Albert Clará Velasco |
| author_sort | Eduardo Mateos Torres |
| collection | DOAJ |
| description | Introduction: Duplex ultrasound (DUS) is increasingly used before vascular access (VA) surgery for haemodialysis. However, the cost-effectiveness of this approach is unknown. Our objective was to assess whether the introduction of a specialised consultation with DUS assessment modifies the cost and the time delay to achieve a first VA valid for haemodialysis. Patients and methods: Prospective cohort of patients undergoing a first VA (June 2014-July 2017) after a specialised consultation with DUS (ECO group). They were compared with a historical cohort (January 2012-May 2014) where VA was indicated exclusively by clinical evaluation (CLN group). We analysed the cost related to visits, DUS assessments, interventions, hospital admissions and graft materials to achieve a first VA valid for haemodialysis at least during 1 month. Results: 86 patients in the CLN group were compared with 92 in the ECO group. Patients in the ECO group were younger (68.4 vs. 64.0 years; P=.038) but no other differences were seen among groups. The average cost to achieve a first AV valid for haemodialysis was significantly lower in the ECO group (2707 vs. 3347€; P=.024). There was a higher cost associated with DUS assessments in the ECO group yet the CLN group had a higher cost related to follow-up visits, successive surgical interventions, prosthetic material, days of hospital admission and catheters. The mean time needed to achieve a first AV valid for haemodialysis was also shorter in the ECO group (49.9 vs. 82.9 days, P=.002). Conclusion: The introduction of a specialised vascular access consultation with DUS prior to VA surgery has reduced the cost necessary to achieve a first VA valid for haemodialysis. From the patient's point of view this has meant less interventions and hospital admissions and a shortening of the time delay. Resumen: Introducción: La valoración mediante eco-doppler (ED) previa a la realización de un acceso vascular (AV) está cada vez más extendida, pero existen pocos estudios que aborden su coste/efectividad. Nuestro objetivo fue evaluar si la introducción de una consulta específica de AV con ED modifica el coste, los tiempos de demora, el número de re-intervenciones e ingresos para lograr un primer AV útil. Pacientes y métodos: Cohorte prospectiva de pacientes sometidos a un primer AV (junio 2014-julio 2017), a quienes se practicó un ED preoperatorio (grupo ECO). Se compararon con una cohorte histórica (enero 2012-mayo 2014) de primeros AV indicados exclusivamente mediante valoración clínica (grupo CLN). Se calcularon los costes de realización y el seguimiento para lograr un AV útil para hemodiálisis durante como mínimo un mes sin complicaciones. Resultados: Se compararon 86 pacientes del grupo CLN con 92 del ECO, siendo estos últimos más jóvenes (68,4 vs. 64,0 años; p = 0,038). El coste medio del grupo ECO fue significativamente inferior (ECO = 2.707 vs. CLN = 3.347 €; p = 0,024). El grupo ECO tuvo un coste mayor en ecografías preoperatorias y de seguimiento. El grupo CLN tuvo un coste superior respecto a consultas de seguimiento, intervenciones quirúrgicas sucesivas, material protésico, días de ingreso y catéteres. Se disminuyó el tiempo de demora para la realización del AV (CLN = 82,9 vs. ECO = 49,9 días; p = 0,002). Conclusión: La introducción de una consulta específica de AV para hemodiálisis con valoración ED, ha permitido disminuir el coste para lograr un primer AV útil, como consecuencia de una reducción en los tiempos de demora, visitas de control, re-intervenciones, días de ingreso e implantación de catéteres. |
| first_indexed | 2024-04-14T01:31:03Z |
| format | Article |
| id | doaj.art-7d4c0b0c5f1f4ec59857d1557f260fc7 |
| institution | Directory Open Access Journal |
| issn | 2013-2514 |
| language | English |
| last_indexed | 2024-04-14T01:31:03Z |
| publishDate | 2022-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Nefrología (English Edition) |
| spelling | doaj.art-7d4c0b0c5f1f4ec59857d1557f260fc72022-12-22T02:20:11ZengElsevierNefrología (English Edition)2013-25142022-01-014212227A cost-effectiveness analysis of the introduction of a specialised consultation with duplex ultrasound assessment prior to vascular access surgery for haemodialysisEduardo Mateos Torres0Silvia Collado Nieto1Maria Dolores Arenas Jimenez2Mónica Lacambra Peñart3Lidia Marcos Garcia4Albert Clará Velasco5Servicio de Angiología y Cirugía Vascular, Hospital del Mar, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain; Corresponding author.Servicio de Nefrología, Hospital del Mar, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Barcelona, SpainServicio de Nefrología, Hospital del Mar, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Barcelona, SpainServicio de Angiología y Cirugía Vascular, Hospital del Mar, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Barcelona, SpainServicio de Angiología y Cirugía Vascular, Hospital del Mar, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Barcelona, SpainServicio de Angiología y Cirugía Vascular, Hospital del Mar, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, SpainIntroduction: Duplex ultrasound (DUS) is increasingly used before vascular access (VA) surgery for haemodialysis. However, the cost-effectiveness of this approach is unknown. Our objective was to assess whether the introduction of a specialised consultation with DUS assessment modifies the cost and the time delay to achieve a first VA valid for haemodialysis. Patients and methods: Prospective cohort of patients undergoing a first VA (June 2014-July 2017) after a specialised consultation with DUS (ECO group). They were compared with a historical cohort (January 2012-May 2014) where VA was indicated exclusively by clinical evaluation (CLN group). We analysed the cost related to visits, DUS assessments, interventions, hospital admissions and graft materials to achieve a first VA valid for haemodialysis at least during 1 month. Results: 86 patients in the CLN group were compared with 92 in the ECO group. Patients in the ECO group were younger (68.4 vs. 64.0 years; P=.038) but no other differences were seen among groups. The average cost to achieve a first AV valid for haemodialysis was significantly lower in the ECO group (2707 vs. 3347€; P=.024). There was a higher cost associated with DUS assessments in the ECO group yet the CLN group had a higher cost related to follow-up visits, successive surgical interventions, prosthetic material, days of hospital admission and catheters. The mean time needed to achieve a first AV valid for haemodialysis was also shorter in the ECO group (49.9 vs. 82.9 days, P=.002). Conclusion: The introduction of a specialised vascular access consultation with DUS prior to VA surgery has reduced the cost necessary to achieve a first VA valid for haemodialysis. From the patient's point of view this has meant less interventions and hospital admissions and a shortening of the time delay. Resumen: Introducción: La valoración mediante eco-doppler (ED) previa a la realización de un acceso vascular (AV) está cada vez más extendida, pero existen pocos estudios que aborden su coste/efectividad. Nuestro objetivo fue evaluar si la introducción de una consulta específica de AV con ED modifica el coste, los tiempos de demora, el número de re-intervenciones e ingresos para lograr un primer AV útil. Pacientes y métodos: Cohorte prospectiva de pacientes sometidos a un primer AV (junio 2014-julio 2017), a quienes se practicó un ED preoperatorio (grupo ECO). Se compararon con una cohorte histórica (enero 2012-mayo 2014) de primeros AV indicados exclusivamente mediante valoración clínica (grupo CLN). Se calcularon los costes de realización y el seguimiento para lograr un AV útil para hemodiálisis durante como mínimo un mes sin complicaciones. Resultados: Se compararon 86 pacientes del grupo CLN con 92 del ECO, siendo estos últimos más jóvenes (68,4 vs. 64,0 años; p = 0,038). El coste medio del grupo ECO fue significativamente inferior (ECO = 2.707 vs. CLN = 3.347 €; p = 0,024). El grupo ECO tuvo un coste mayor en ecografías preoperatorias y de seguimiento. El grupo CLN tuvo un coste superior respecto a consultas de seguimiento, intervenciones quirúrgicas sucesivas, material protésico, días de ingreso y catéteres. Se disminuyó el tiempo de demora para la realización del AV (CLN = 82,9 vs. ECO = 49,9 días; p = 0,002). Conclusión: La introducción de una consulta específica de AV para hemodiálisis con valoración ED, ha permitido disminuir el coste para lograr un primer AV útil, como consecuencia de una reducción en los tiempos de demora, visitas de control, re-intervenciones, días de ingreso e implantación de catéteres.http://www.sciencedirect.com/science/article/pii/S2013251422000153Fístula arteriovenosaAcceso vascularHemodiálisisEcografía doppler preoperatoriaCoste/efectividad |
| spellingShingle | Eduardo Mateos Torres Silvia Collado Nieto Maria Dolores Arenas Jimenez Mónica Lacambra Peñart Lidia Marcos Garcia Albert Clará Velasco A cost-effectiveness analysis of the introduction of a specialised consultation with duplex ultrasound assessment prior to vascular access surgery for haemodialysis Nefrología (English Edition) Fístula arteriovenosa Acceso vascular Hemodiálisis Ecografía doppler preoperatoria Coste/efectividad |
| title | A cost-effectiveness analysis of the introduction of a specialised consultation with duplex ultrasound assessment prior to vascular access surgery for haemodialysis |
| title_full | A cost-effectiveness analysis of the introduction of a specialised consultation with duplex ultrasound assessment prior to vascular access surgery for haemodialysis |
| title_fullStr | A cost-effectiveness analysis of the introduction of a specialised consultation with duplex ultrasound assessment prior to vascular access surgery for haemodialysis |
| title_full_unstemmed | A cost-effectiveness analysis of the introduction of a specialised consultation with duplex ultrasound assessment prior to vascular access surgery for haemodialysis |
| title_short | A cost-effectiveness analysis of the introduction of a specialised consultation with duplex ultrasound assessment prior to vascular access surgery for haemodialysis |
| title_sort | cost effectiveness analysis of the introduction of a specialised consultation with duplex ultrasound assessment prior to vascular access surgery for haemodialysis |
| topic | Fístula arteriovenosa Acceso vascular Hemodiálisis Ecografía doppler preoperatoria Coste/efectividad |
| url | http://www.sciencedirect.com/science/article/pii/S2013251422000153 |
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