What are the reported procedural costs of vascular access surgery?

Introduction: Since the inception of arteriovenous grafts (AVG) as a novel technique, there has been greater emphasis on the assessment of outcomes rather than costs. Gross-costing methods over-simplify vascular access surgery and do not reflect the true costs of the service, preventing accurate cost-effectiveness analysis. The aim of this study is to assess the reporting of procedural costs of arteriovenous access creation in economic analyses of vascular access surgery, and to compare the reported costs of the two most performed procedures - arteriovenous fistula (AVF) and arteriovenous graft (AVG).

Methods: This systematic review included studies reporting a per-procedure cost for AVF or AVG creation. Costs were adjusted from original to target price year using a Gross Domestic Product (GDP) deflator index and converted to 2021 US Dollars using conversion rates based on purchasing power parities.

Results: The results demonstrate wide discrepancy in the reported procedural costs of arteriovenous access creation. Most of the data represents retrospectively observed costs rather than prospective data collected on an intention-to-treat basis. Charges are frequently presented in lieu of costs, and aggregated gross-costing methodology predominates rather than more accurate micro-costing.

Conclusion: Future micro-costing studies of vascular access surgery are essential to allow a greater understanding of cost-drivers and allow accurate cost-effectiveness analysis.