Cost-benefit analysis of a tracking program for arteriovenous fistula maturation

Fail-to-mature (FTM) of arteriovenous fistula (AVF) imposes suffering onto hemodialysis patients and increases cost burden to the healthcare system. FTM may result from delayed maturation-assisting procedures, patients' non-compliance or interdisciplinary miscommunication. A tracking program for AVF maturation was shown to improve clinical outcomes, however, extra manpower was required. This study aimed to evaluate the economic sustainability of the program.

Data from two cohorts of patients (without tracking and with tracking) was collected retrospectively. A decision tree model was built to conduct a cost-benefit analysis comparing the cost pertaining to AVF maturation with and without the tracking program. The transitional probabilities in base case analysis were obtained from the study cohort. The costs of various procedures and manpower for tracking were extracted from official government websites. Sensitivity analysis were conducted to take account of uncertainties in parameters.

In the study, 114 and 141 newly created AVFs from without-tracking and tracking group, respectively, were analyzed. The base-case study considered 21 possible scenarios (11 for pre-tracking and 10 for post-tracking). Manpower required for maturation tracking imposed a cost of S$33,644 per year. Without-tracking yields an expected AVF-related cost of S$7151, which was higher than that of the tracking group (S$6510). Assuming 120 AVFs created per year, the net monetary benefit obtained from the tracking program was estimated to be S$74,944 over 1 year. Sensitivity analysis suggested that the findings were robust for changes in both transitional probabilities and cost incurring events.

AVF maturation tracking program yields economic benefit to the healthcare system.