Cost-effectiveness Analysis of Vascular Access Referral Policies in CKD

Background The optimal timing of vascular access referral for patients with chronic kidney disease who may need hemodialysis (HD) is a pressing question in nephrology. Current referral policies have not been rigorously compared with respect to costs and benefits and do not consider patient-specific factors such as age. Study Design Monte Carlo simulation model. Setting & Population Patients with chronic kidney disease, referred to a multidisciplinary kidney clinic in a universal health care system. Model, Perspective, & Timeframe Cost-effectiveness analysis, payer perspective, lifetime horizon. Intervention The following vascular access referral policies are considered: central venous catheter (CVC) only, arteriovenous fistula (AVF) or graft (AVG) referral upon HD initiation, AVF (or AVG) referral when HD is forecast to begin within 12 (or 3 for AVG) months, AVF (or AVG) referral when estimated glomerular filtration rate is