OBJECTIVES: Tunnelled central venous catheters (TCVCs) are frequently used for patients requiring urgent vascular access for haemodialysis (HD), whilst they await definitive access creation, primarily arteriovenous fistula (AVF). TCVCs are associated with significant complications notably higher rates of septicaemia which are costly to treat. Early cannulation arteriovenous grafts (ecAVGs) are a new alternative providing vascular access for HD within 24 hours post implantation. We estimated the potential budget impact in a single hospital of replacing TCVCs with ecAVG’s for clinically suitable patients while they awaited a functioning AVF. The analysis was used to understand the potential financial implications of adopting ecAVGs and to inform the decision to conduct a Randomised Controlled Trial (RCT) to study the above hypothesis. METHODS: A budget impact model was used to estimate the total costs to the hospital of the two treatment strategies. Costs of procedures, re-interventions and septicaemia were included. Clinical inputs including referral delays for treatment and patient acceptability of ecAVG’s, were taken from a 6 month observational study conducted at the hospital, internal audits and published literature. We assumed re-intervention and septicaemia rates of ecAVG were equivalent to standard AVGs. Resource use was based on hospital practice and unit costs from published National Health Service datasets. RESULTS: Over a 6 month period, total treatment costs per patient were £5,882 in the TCVC strategy and £4,954 in the ecAVG strategy, delivering potential savings of £927 per patient. Although ecAVG’s had higher procedure and re-intervention costs reflecting longer procedure time and device costs (£3,014 vs £1,836), these were offset by significant reductions in septicaemia treatment costs (£1,322 vs £2,176) and in-patient waiting time bed costs (£619 vs £1,870). CONCLUSIONS: Adopting ecAVG’s as an alternative to TCVCs can potentially deliver cost savings in this hospital. The two treatment strategies will now be assessed in a RCT.