The major costs of access complications are triggered when a patient thromboses and then converts from an AV access to a catheter, even if only for a brief period. Besides a disruption to operations, the facility incurs real costs because of increased catheter treatments and more missed treatments. To determine the costs related to these adverse events, we examined 1,811 patients in our database that converted from an AV access to a catheter in 2019 and 2020, and then followed each patient forward in the treatment record for at least a full year1 or until they started using an AV access again. From this analysis, the average patient that converted missed 5.6 treatments and had 65 treatments on catheter before they return to an AV access, or the treatment record stops.
Cost to the Facilities
While net revenue per dialysis treatment varies by provider, if you assume $280 net revenue for a missed treatment2 and $30 of extra cost for a catheter treatment3, the average conversion costs $3,5354. Projecting this for a facility of 100 patients with arteriovenous accesses, we can assume various yearly conversion rates5.
- Conversion rate of 6% or 6 patients: $21,210
- Conversion rate of 9% or 9 patients: $31,815
- Conversion rate of 12% or 12 patients: $42,420
Vasc-Alert Value Proposition
It is common for new accounts initiating Vasc-Alert to reduce access conversions by 50% or more. See following infographic. At a price of $100/patient per year, Vasc-Alert costs $10,000. A facility that has a historical conversion factor of 6% can therefore safely assume savings of one half of $21,210 or $10,605.
🡺 Vasc-Alert pays for itself even at the lower 6% conversion rate with positive income for higher rates.
Impact of Conversions on Average Facility Patient Catheter Count
The total time that patients who convert spend on a catheter is about 5 months (65 Txs / 13). For 6 patients that converted, their total time on a catheter would be 30 months or about 2.5 patient years. This means that at any given time, the facility would have at least 2 patients on a catheter due to access issues.
Resulting Access after Conversion
By following conversions forward, we can determine whether a patient returns to their original access, receives a new AV access, or remains on a catheter. To provide sufficient time for a patient to return to an AV access, we followed each patient forward for at least 12 months following their conversion and found the following:
- A new AV access was placed: 40%
- Patient returned to their original access: 33%
- Patient remained on a catheter: 27%
For facilities participating in value-based care programs, these results have major implications for the cost model: expensive procedures, increased hospitalization, and costs related to new access placements.
Improving vascular access care using Vasc-Alert can more than pay for itself even under the current reimbursement model. With value-based reimbursement on the horizon, improving access care is a critical element for success.
1 Conversions from 2019 and 2020 were followed forward until the end of 2021 or the patient returned to an AV access.
2 Missed Tx cost estimate: published average revenue per Tx for LDOs is $350, less $70 in consumables not used = $280.
3 Cather cost: an estimate of costs of components, drugs, and extra time of a nurse.
4 Missed Tx costs: 5.6 Txs X $280 = $1,568 Catheter usage cost: 65.6 Txs X $30 = $1,968. Total cost: $3,535
5 New facilities to Vasc-Alert typically have conversion rates in the range of 7% to 12% with an average of 9%.