masterThesis
Accesos vasculares para hemodiálisis, cuál es el más costo efectivo?
Fecha
2014Autor
Tarazona Lara, Marcos Manuel
Viñas Granadillo, Alvaro Jose
Institución
Resumen
Background: end stage chronic renal disease is a serious public health problem in our country because of the big economic burden that is spent on its management. Hemodialysis is the most used treatment in our setting; vascular access and its derived complications are the most important aspect for raising attention’s costs in this group of patients. Materials and methods: an economical study was undertaken with the hemodialysis incident patients attended in RTS-Fundación Cardio Infantil agency during 2012. The costs of creation, maintenance and complication management of the vascular access via central venous catheter, native arteriovenous fistula and graft arteriovenous fistula were established. The probability of complication occurrence was calculated and a decision tree model was used to establish the behavior or each access in a five years period. The quality adjusted life years (QALYs) were established for each access and the economic ratio for each QALY was calculated also. Results: there were 36 incident hemodialysis patients in 2012, 100% started hemodialysis via central venous catheter, 16 patients change their access to a native arteriovenous fistula, 1 to a graft arteriovenous fistula and latter to CAPD, 15 patients continued with central venous catheter and 4 patients died. In 5 years 2, 36 QALY were obtained for central venous catheter patients that cost $ 24. 813. 036, 39/QALY and 2, 535 QALY for arteriovenous fistula with a ratio of $ 6. 634. 870, 64/QALY. Conclusions: the present study demonstrates that native arteriovenous fistula is a more cost-effective vascular access for hemodialysis than central venous catheters.