11 research outputs found
Evaluation of variables associated with the patency of arteriovenous fistulas for hemodialysis created by a nephrologist
A mixed-methods investigation of incident Hemodialysis access in a safety-net population
Agreement of reported vascular access on the medical evidence report and on medicare claims at hemodialysis initiation
Cost-effectiveness analysis of timely dialysis referral after renal transplant failure in Spain
<p>Abstract</p> <p>Background</p> <p>A cost-effectiveness analysis of timely dialysis referral after renal transplant failure was undertaken from the perspective of the Public Administration. The current Spanish situation, where all the patients undergoing graft function loss are referred back to dialysis in a late manner, was compared to an ideal scenario where all the patients are timely referred.</p> <p>Methods</p> <p>A Markov model was developed in which six health states were defined: hemodialysis, peritoneal dialysis, kidney transplantation, late referral hemodialysis, late referral peritoneal dialysis and death. The model carried out a simulation of the progression of renal disease for a hypothetical cohort of 1,000 patients aged 40, who were observed in a lifetime temporal horizon of 45 years. In depth sensitivity analyses were performed in order to ensure the robustness of the results obtained.</p> <p>Results</p> <p>Considering a discount rate of 3 %, timely referral showed an incremental cost of 211 €, compared to late referral. This cost increase was however a consequence of the incremental survival observed. The incremental effectiveness was 0.0087 quality-adjusted life years (QALY). When comparing both scenarios, an incremental cost-effectiveness ratio of 24,390 €/QALY was obtained, meaning that timely dialysis referral might be an efficient alternative if a willingness-to-pay threshold of 45,000 €/QALY is considered. This result proved to be independent of the proportion of late referral patients observed. The acceptance probability of timely referral was 61.90 %, while late referral was acceptable in 38.10 % of the simulations. If we however restrict the analysis to those situations not involving any loss of effectiveness, the acceptance probability of timely referral was 70.10 %, increasing twofold that of late referral (29.90 %).</p> <p>Conclusions</p> <p>Timely dialysis referral after graft function loss might be an efficient alternative in Spain, improving both patients’ survival rates and health-related quality of life at an affordable cost. Spanish Public Health authorities might therefore promote the inclusion of specific recommendations for this group of patients within the existing clinical guidelines.</p
Early application of an intermittent pneumatic compression device is safe and results in proximal arteriovenous fistula enlargement
Characterization and assessment of potential environmental risk of tailings stored in seven impoundments in the Aries river basin, Western Romania
Evaluation of upper limb superficial venous percussion as a sign of anatomical location and venous permeability. A comparative study of superficial venous percussion to ultrasound findings on non-renal patients and on chronic kidney disease patients
Reframing Garbage: Solid Waste Policy Formulation in Nova Scotia
This case study provides important lessons to governments interested in developing an alternative policy for solid waste other than the traditional disposal-reliance paradigm