OBJECTIVES:  Stenosis is a common cause of hemodialysis vascular access failure and is associated with high costs. Percutaneous transluminal angioplasty (PTA) is considered standard care for vascular access stenosis; however, patency rates are low. Bare metal stents (BMS) are sometimes used, but no randomized trials of current BMS are available for this condition. In contrast, level 1 evidence supports the superiority of covered stents (CS), including Flair^® and Fluency^®Plus Endovascular Stent Grafts, compared to PTA in vascular access stenosis. This study quantified the change in total costs when increasing the use of CS versus current care, from a U.S. provider and payer perspective for arteriovenous graft stenosis.

METHODS:  The analyses compared initial device and re-intervention costs over 24-months in a current real-world treatment mix (i.e., 90% PTA, 5% BMS, 5% CS) versus a future treatment mix (i.e., 82.5% PTA, 2.5% BMS, 15% CS). Costs for analyses were based on Medicare 2016 reimbursement amounts and company internal data, respectively. Re-intervention rates were from randomized trials of the endovascular stent grafts. BMS efficacy for reinterventions was assumed to be identical to PTA based on observational data. The payer and provider analyses assumed population sizes of 200,000 and 500 patients, respectively.

RESULTS: : From the payer perspective, the increased use of CS was estimated to have cost-savings of $27.63 million compared to the current mix. From the provider perspective, increased CS use increased initial costs but decreased downstream costs with an estimated cost impact of $48,307 over 500 patients.

CONCLUSIONS:  Increasing the use of CS by 10% was predicted to provide cost savings for U.S. payers due to avoided re-interventions and have a small cost impact for hospital providers. Covered stents, such as Flair