The price of dialysis access: Implications of access type and patient-centric approaches to cost

Nathan Sim, Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image-Guided Medicine, Emory School of Medicine, Atlanta, GA, USA.
Hanzhou Li, Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image-Guided Medicine, Emory School of Medicine, Atlanta, GA, USA.
John T. Moon, Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image-Guided Medicine, Emory School of Medicine, Atlanta, GA, USA.
Anirudh Bikmal, Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image-Guided Medicine, Emory School of Medicine, Atlanta, GA, USA.
Deepak Iyer, Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image-Guided Medicine, Emory School of Medicine, Atlanta, GA, USA.
Brian Byun, Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image-Guided Medicine, Emory School of Medicine, Atlanta, GA, USA.
Menelaos Konstantinidis, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
Victoria Teodorescu, Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Emory School of Medicine, Atlanta, GA, USA.
Janice Newsome, Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image-Guided Medicine, Emory School of Medicine, Atlanta, GA, USA.
Zachary Bercu, Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image-Guided Medicine, Emory School of Medicine, Atlanta, GA, USA.

Document Type

Journal Article

Publication Date

11-7-2024

Journal

The journal of vascular access

DOI

10.1177/11297298241290548

Keywords

AV fistula; Dialysis; dialysis access; economics and health services; peritoneal access; prosthetic grafts

Abstract

PURPOSE: This study explores out-of-pocket (OOP) costs for patients and provider reimbursement for dialysis access creation. It aims to illustrate the financial characteristics of four dialysis access modalities to consider in decision-making for clinicians, patients, and payers. MATERIALS AND METHODS: Retrospective data from the Merative™ MarketScan Commercial Claims and Encounters Databases from 2017 to 2022 was analyzed for patients who received an arteriovenous fistula (AVF), arteriovenous graft (AVG), peritoneal dialysis catheter (PDC), or percutaneous AVF (pAVF). ANOVA and Tukey HSD were used to assess cost differences among the four access modalities overall and in the context of insurance type and service site. RESULTS: Database extraction resulted in 20,863 unique procedures, comprising of 15,043 AVF, 4759 AVG, 896 PDC, and 165 pAVF. Mean age was 59.2 years (±14.19) and 60.53% of the cohort was male. EPO/PPO plans were the most represented (53.06%) and most procedures were performed in the hospital outpatient department (91.99%). There were significant differences found among OOP cost and reimbursement with respect to procedure type, insurance type, and service site. Overall, pAVF had both the highest cost and reimbursement. CONCLUSION: Patient OOP costs and provider reimbursement differ significantly based on procedure, insurance type, and service site. While pAVF creation is recognized with high reimbursements due to its complexity and the advanced technology required, it also has the highest OOP costs for patients. To help facilitate adoption of new technologies like pAVF, advocacy efforts should focus on encouraging payers to lower the OOP financial barriers for patients to receive these newer but costlier procedures.

Department

School of Medicine and Health Sciences Student Works

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