Mohapatra A, Yuo TH, Lowenkamp MN, et al. - Relative to standard arteriovenous grafts (sAVGs), higher costs are conferred by immediate-access arteriovenous grafts (IAAVGs), or early cannulation arteriovenous grafts (AVGs), but with immediate usability after placement and reduction in the need for a tunneled dialysis catheter (TDC). Researchers here examined whether a decrease in TDC-related complications makes IAAVGs a cost-effective alternative to sAVGs. A Markov state-transition model was created in which patients initially had either an IAAVG or an sAVG and a TDC until graft usability; follow up of patients was performed through multiple subsequent access procedures for a 60-month time horizon. Under both real-world ($1201.16 less expensive and 0.03 QALY more effective) and ideal ($1457.97 less expensive and 0.03 QALY more effective) conditions, IAAVG placement is identified to be a dominant strategy. IAAVGs are identified as cost-effective if a TDC is maintained for ≥ 23 days after sAVG placement. Lower mean catheter time was noted with IAAVG (3.9 vs 8.7 months), as was the mean number of access-related infections (0.55 vs 0.74). Findings support that despite the added initial cost, IAAVGs are finally cost-saving and more effective. This apparent benefit is due to the assumption that a reduced number of catheter days per patient would result in a reduced number of access-related infections.