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Kidney Week

Abstract: PO0814

Potential Cost Savings Associated with the Reduction of Hospital Admissions by Using Online High-Volume Hemodiafiltration (Hv-HDF) vs. High-Flux hemodialysis (Hf-HD)

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis


  • Ficociello, Linda, Fresenius Medical Care, Global Medical Office, Waltham, Massachusetts, United States
  • Farahati, Farah, Fresenius Medical Care, Global Medical Office, Waltham, Massachusetts, United States
  • Mullon, Claudy, Fresenius Medical Care, Global Medical Office, Waltham, Massachusetts, United States
  • Anger, Michael S., Fresenius Medical Care, Global Medical Office, Waltham, Massachusetts, United States

On-line HDF for maintenance dialysis patients is available in Europe and Canada but is essentially absent in the US. The National Institute for Health and Care Excellence (NICE) conducted a systematic review and built economic models to compare hemodiafiltration (HDF) with Hf-HD. They found HDF to be cost-effective due to benefits such as increased survival and reduced medication requirements. In addition, NICE found HDF using high convection volumes ~20+ L (HvHDF) had greater mortality benefits compared to Hf-HD. Economic models built upon payment systems outside of the US may be difficult to apply within the US due to differing payment structures. This analysis estimates the potential cost-savings associated with reducing hospital admissions with online HvHDF (vs Hf-HD) based on published studies and USRDS cost data.


We updated the NICE systematic literature review on HDF studies, especially for articles on hospitalization by searching EMBASE (Ovid), PubMed and NHS EED from 2010 to present. We used an input-output Microsoft Excel® database to calculate the potential cost-saving of online HvHDF compared to Hf-HD from reducing hospitalization and estimating the savings associated with those averted hospitalization and missed in-center HD. The average cost of hospitalization was derived from USRDS and adjusted to 2021 ($17,181), and the average hospital stay was 6.42 days and assuming thrice weekly would result in 2.75 missed HD treatments. It is assumed that reimbursement rate for in-center HD is $253.13 per treatment and costs of treating with HvHDF and Hf-HD are equivalent.


Out of 107 studies found, 4 reported hospitalization rates for HDF and Hf-HD, and 1 compared HvHDF with Hf-HD. This study found 10.8 fewer hospital admissions with HDF per 100 patient-years (Maduell, et al, High efficiency postdilution online hemodiafiltration reduces all-cause mortality in hemodialysis patients. J Am Soc Nephrol, 2013: 487-97). We identified potential saving of $1,856 per patient per year (PPPY) due to averted hospitalizations and $75 PPPY due to avoiding missed HD treatment for a total of $1,931 PPPY.


The potential annual cost-savings of using HvHDF over Hf-HD in maintenance in-center HD was estimated as $1,931 PPPY or $193,071 per 100 patients.


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