Cost comparison of online haemodiafiltration with high-flux haemodialysis

Abstract

Haemodiafiltration increases convective clearances, and online haemodiafiltration (OL-HDF) was introduced to reduce costs of producing large volumes of ultrapure water. Previous reports have suggested that OL-HDF may be a cost-saving therapy by reducing recombinant human erythropoietin requirements and those for other medications. We therefore costed OL-HDF with high-flux haemodialysis. Thirty-four patients dialysing (Tue/Thu/Sat) switched to OL-HDF, and 44 dialysing (Mon/Wed/Fri) remained on high-flux haemodialysis (HD) in a satellite dialysis centre. They were then prospectively followed for 12 months. Depending upon whether blood lines with a cuvette for measuring relative blood volume were used, OL-HDF was either slightly more expensive per session, by £1.16, as the cost of the reinfusion line outweighed any potential savings in 0.9% saline usage, or cheaper by £0.78 if standard blood lines were used. Although there were initial increased costs for more frequent testing of dialysis machine water quality. It could be argued that similar water quality is required for high-flux haemodialysis using dialysers with increased internal filtration. There was no cost saving in terms of recombinant human erythropoietin prescription, but whereas weekly phosphate binder costs increased in the high-flux haemodialysis cohort from £3.8 (range 1.9-14.8) to £5.0 (range 1.9-21.3; p=0.01), costs did not change with OL-HDF (£3.8, range 1.9-11.9). Depending upon the choice of blood lines, OL-HDF was either a slightly more expensive or a cheaper treatment per session compared with high-flux haemodialysis in our centre. Treatment with OL-HDF also led to modest cost savings on phosphate binders.