Abstract: FR-PO0457
Economic Impact of Online High-Volume Hemodiafiltration in a Brazilian Private Health System: A Real-World Cost Analysis from 2018-2023
Session Information
- Dialysis: Hemodiafiltration, Ultrafiltration, Profiling, and Interdialytic Symptoms
November 07, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Author
- Silveira Junior, Sergio Antonio Dias Da, Prevent Senior Private Operadora de Saude Ltda, São Paulo, SP, Brazil
Background
Despite growing evidence of the clinical advantages of online high-volume hemodiafiltration (HDF), limited data exist on its economic implications in real-world settings, particularly within middle-income countries. This study aimed to assess the financial impact of incorporating HDF in Brazil's private health sector.
Methods
We conducted a retrospective cost analysis of 2,167 patients with ESRD treated between 2018 and 2023 by a large Brazilian private health plan. Patients were classified into three groups: (1) conventional HD, (2) exclusive HDF online, and (3) HD→HDF converters. We analyzed five cost domains: emergency care, hospital admissions, outpatient services, high-complexity procedures, and dialysis treatments. Difference-in-differences models and Callaway & Sant’Anna estimators were applied to estimate causal effects. Annual per-patient expenditures and cost per clinical event were compared across groups.
Results
HDF patients had higher dialysis-related costs (+12.8%) but showed significant cost reductions in other domains: emergency care (–18.4%, p<0.01), outpatient services (–16.7%, p<0.01), and high-complexity procedures (–14.2%, p<0.05). Hospital admission costs showed no significant difference. Total mean annual cost per patient was lower in the HDF group compared to HD (R$37,100 vs. R$41,700; p<0.05), indicating favorable cost-effectiveness.
Conclusion
Despite higher procedural expenses, online HDF led to a net reduction in total healthcare spending by preventing high-cost clinical events. These findings support the economic sustainability of HDF implementation within private health systems.