Hemodialysis patients and complications management costs in Italy: Plastic cannulae a potentially cost-effective strategy

Background: The treatment of end-stage chronic renal failure involves substantial costs for health care, which could be higher considering hemodialysis access complications management costs. Complications could be addressed by cannulation technique, but also by the needle. In particular, the use of a metal needle for cannulation is responsible for several complications that compromise dialysis delivery and require interventions. This analysis aims to evaluate, from a hospital perspective, the direct costs related to complications that may occur in hemodialysis patients in Italy. Methods: To identify the main complications to consider in our analysis and related patient pathway for their management, we conducted an international literature search on PubMed and validated the data for Italy with an Italian Key Opinion Leader (KOL). A micro-costing analysis was developed to precisely assess the economic costs of healthcare interventions to manage complications due to vascular access cannulation. Results: The major complications identified, and the average cost/per episode for their management are the following ones: Local infection euro 1455 (min euro 745 and max euro 2160); Sepsis, that requires hospitalization in ward euro 4401 (min euro 3693 and max euro 4623); Sepsis (ICU) euro 17,190; Hematoma euro 304 (min euro 252 and max euro 728); Aneurysm euro 3632 (min euro 3139 and max euro 4014); Pseudoaneurysm euro 3695 (min euro 3615 and max euro 4014); Stenosis euro 2229 (min euro 1874 and max euro 4857); Thrombosis euro 2151 (min euro 1941 and max euro 3395). Conclusions: In making decisions, hospital administration, and payer should take into consideration, not just the price of devices, but the entire patient's pathway. The use of plastic cannulae in hemodialysis patients shows improved outcomes compared to traditional metal needles. Furthermore, combining it with accurate and efficient cannulation techniques reduces complication rates, improves patients' quality of life, and reduces healthcare resource consumption.