Metal Needles Versus Plastic Cannulae in Hemodialysis Patients: A Cost-Benefit Analysis

OBJECTIVES: Successful cannulation of an arteriovenous fistula in maturation is important in patients starting hemodialysis. Metal needles are used in regular clinical practice. Plastic cannulae by design might provide a less traumatic cannulation. Plastic cannulae are positioned with a higher price compared to metal needles. The objective of the study was to determine the cost-benefit of plastic cannulae vs. metal needles.

METHODS: A static decision tree model was conceptualized to estimate the cost-benefit of implementing plastic cannulae in a hypothetical cohort of 100 hemodialysis patients from a European hospital perspective. Input parameters in literature were restricted to the event rate and cost of managing complications: stenosis, aneurysm, angioplasty at cannulation site, angioplasty with thrombolysis, and device costs. One way sensitivity analysis (OWSA) was carried out varying each input parameter by 25% and threshold analysis was also performed.

RESULTS: The results showed that incremental costs of plastic cannula over metal needles is offset by higher costs of adverse events for metal needles. Cost per month per patient with metal needles was €330.15 vs. €210.13 with plastic cannulae corresponding to cost savings of €120.02 or 36.35% for plastic cannulae compared to metal needles. The OWSA showed the following ranking of cost drivers: price of plastic cannulae (major driver of cost savings), followed by the cost per episode of aneurysm, stenosis, angioplasty with thrombolysis, angioplasty at the cannulation site, and costs of metal needle, respectively. The threshold analysis showed that €7.5 was the price of one plastic cannula (vs. €0.1 for metal needles) beyond which complications could not off-set price differences.

CONCLUSIONS: Our results applicable specifically to Europe are similar to previous work on advantages of plastic cannulae (Tito 2022) and (Marticorena 2018). This study is unique as it includes OWSA and threshold analysis. Plastic cannulae are cost saving compared to metal needles in hemodialysis patients.