Improved AV Fistula Usability with Fewer Interventions Leads to Reduced Annualized Cost of AV Fistula Patients: A Propensity Score-Matched Comparative Prospective Study

A vascular external support for arteriovenous fistula (AVF) creation (VasQ, Laminate Medical, Tel Aviv, Israel) has improved functional success in multiple European studies. Herein is the first complete report of U.S. Pivotal Comparative Study results with a cost analysis presented VasQ over 24-month period. The study prospectively enrolled 144 patients (90% brachiocephalic and 10% radiocephalic) at 15 sites. group 782 treated by same surgeons from immediately prior to trial enrollment period was developed Medicare claims database as comparative group. Demographic, procedural postprocedural data were collected up 24 months after surgery. To emulate randomized studies, propensity score weighting method (inverse probability treatment using average effect) applied data. Statistical comparisons primary patency (freedom intervention), (continuous use dialysis minimum 30 days), post-creation intervention rates made against matched comparator well calculating payer cost. Descriptive failure rate (abandonment before 6-month follow-up) cumulative abandonment) published meta-analyses. median diameter vessels AVF site 4.25 mm (range, 2.0-6.6 mm) arterial 3.95 2.3-7.8 venous. Incidence steal (4.2%), infection (0.7%), (pseudo)aneurysm (0.7%) compared favorably standard creations. Demographic control groups typical population (Table I). AVFs demonstrated superior patency, cohort II). Primary 7.9% 22.0% 32.2% reported contemporary Cumulative 76.7% (95% confidence interval, 67.7%-83.4%) meta-analyses reporting 53.7% 63.0% AVFs. No difference observed between requiring interventions those that did not, demonstrating not inhibit ability physicians maintain patency. nearly 50% reduction access 6 resulted an annualized $7764.19 per patient-year. device delivered more success, earlier usability fewer interventions, reducing overall costs creation.Table IMatched demographicsCharacteristicsVasQUnmatched controlUnmatched SMDMatched controlMatched SMDMale61.1% (88/144)56.3% (440/782)9.964.9%−7.9Black35.4% (51/144)47.4% (364/768)−24.531.5%8.3White53.5% (77/144)43.1% (331/768)20.957.9%−9.0Other11.1% (16/144)9.5% (73/768)5.310.6%1.8Mean age58.9 ± 11.460.8 12.7−15.758.7 5.63.0Obesity52.1% (75/144)51.2% (400/782)1.948.3%7.6Active dialysis66.0% (95/144)65.3% (511/782)1.365.7%0.6Diabetic69.4% (100/144)79.0% (618/782)−22.069.4%0.1Congestive heart failure21.5% (31/144)41.6% (325/782)−44.122.8%−3.0SMD, Standard mean difference.Values are (proportion) [range]. Boldface entries indicate statistical significance. Open table new tab Table IIVasQ patient outcomes relative comparatorEndpoint (n)VasQ vs controlOdds ratioMatched P valuePrimary months64.2% 35.5%3.27[2.15-5.17]<.0001Continuous 3 months43.4% 26.7%2.15[1.32-4.47].0069Continuous months72.5% 56.3%2.05[1.23-3.75].0059Intervention months0.97 1.91NA<.0001Values 95% intervals.