Table 3.

Unit costs of vascular access surgery from Ontario Case Costing Initiative costing analysis tool (2011)

Surgery TypeMedian in $ (SD)Point Estimate in $a
Total Cost Per CaseIndirect Cost Per CaseTotal Cost Per Casea
Permanent access-related surgery and interventions
 Access creationa16317194972202128849
 Access revisiona122380046425516871053
CVC-related interventions (CVC use while permanent access in situ)
 Outpatient treatment for vascular access-associated bacteremia per eventb262
 CVC removal and new insertionc1121
 Cost of hospital per day related to CVC-related complications (non-ICU) (price per day)d700
 Cost of rescue tPA for patients who develop CVC malfunctione533
  • CVC, central venous catheter; ICU, intensive-care unit; tPA, tissue plasminogen activator; OCCI, Ontario Case Costing Initiative; TGH-UHN, Toronto General Hospital - University Health Network; PRECLOT, prevention of dialysis CVC malfunction with recombinant tissue plasminogen activator.

  • a Source: OCCI costing analysis tool (2011), the median total costs obtained from OCCI are derived from the sum of the direct costs (i.e., costs directly related to the provision of patient care, such as nursing in the operating room, diagnostic imaging, pharmacy, and laboratory work required) and the indirect costs (i.e., costs which includes overhead expenses, such as those related to managing relevant facility operations) of all patients receiving hemodialysis who had their vascular access-related complications or events in all OCCI hospitals in Ontario during 2011.

  • b Source: UHN Pharmacy costing records, the dose and duration of antibiotic treatment, as well as the cost of laboratory monitoring for the antibiotics were based on the outpatient hemodialysis diagnostic and treatment algorithm as follows. For this study, we assumed that once a catheter-related bacteremia is suspected, two sets of blood cultures, which cost CA$102 per set, are obtained as per guideline recommendations (32). Empirical parenteral vancomycin and an aminoglycoside, tobramycin, are initiated at three administrations per week, until sensitivities and cultures return. The list price of vancomycin and tobramycin were used; the duration of antibiotic use was estimated to be 2 weeks.

  • c Source: TGH-UHN interventional radiology department costing records.

  • d Source: TGH-UHN costing records for ward, the cost of hospitalizations for CVC-associated complications were included in this analysis, but not AV access-related complications because these were not consistently captured in our database.

  • e Source: PRECLOT study.