#5439 HOME DIALYSIS DOES NOT HAVE THE MONOPOLY ON LOW COST

Abstract

Abstract Background and Aims End-stage kidney disease (ESKD) is a major challenge for health-care systems around the world because of its ever-rising rates and the ensuing rise in health-care costs. The objective of this study was to compare the cost of four dialysis modalities that enable patients to play a substantial role in their own care and have social and professional lives. Method We identified all patients in the national French ESKD REIN registry aged 18–65 years who received any dialysis treatment in 2015-2019, used stepwise indirect linkage with the national health database to analyse exhaustive hospital stays and outpatient health-care utilisation. Four treatment groups were defined: non-assisted haemodialysis in self-care units (scHD), non-assisted automated peritoneal dialysis (naAPD), daily home HD (dhHD), and non-hospital-based nocturnal extended hours HD (neHD).Total costs by categories and subcategories were aggregated monthly and by patient. Costs are expressed as their medians and interquartile ranges (Q1-Q3). Results Our study included 1932 patients with 39 966 patient treatment-months. The median monthly cost for one patient was €6154 (IQR €5088 – €7566) and varied from €5700 for naAPD to €7903 € for dhHD. Analysis by cost subcategories showed that the main cost came from dialysis fee payments —60% of the monthly cost. Hospitalization costs came next (11%). The costs of the different subcategories varied between dialysis modalities. During the study period, the hospitalization rate was 33 per 100 months at risk: 14 for inpatient admissions and 19 for day hospitalization. Day hospitalization was more frequent for patients with home treatment. Various compensatory allowances were paid to 49% of the patients. Conclusion Most of the cost difference variability related to payment methods for the different dialysis techniques. Our study shows that different care strategies could be offered to French dialysis patients. Underused techniques such as neHD might usefully be promoted as they do not involve any excess costs, at least compared with dhHD. Real cost analyses are however needed because some reimbursements are not adapted and deserve to be revised upwards.