Cost Analysis for Home and Home-Assisted Renal Replacement Therapy Compared to In-Centre Hemodialysis.

Introduction. Chronic kidney disease (CKD) is a prevalent condition which may require dialysis; the most common form of this is facility-based haemodialysis. This study aims to provide cost estimates for in-centre haemodialysis/haemodiafiltration compared with home-based peritoneal dialysis and haemodialysis, with or without healthcare staff assistance. Methods. A cost analysis was conducted at the Nephrology and Dialysis Units of San Giovanni di Dio Hospital (Florence, Italy) for the following procedures: high- and low-flux bicarbonate HD (39.95.4), HDF (39.95.7), APD (54.98.1), CAPD (54.98.2), and daily home HD for at least 12 hours/week (39.95.O). Costs were calculated on a monthly basis and included direct medical costs, indirect costs, healthcare personnel costs, and patient transportation costs. Results. In-centre bicarbonate hemodialysis and hemodiafiltration showed a monthly cost of €4672 and €4766, respectively. CAPD and APD monthly costs were €1613 and €2080 without, and €4454 and €3774, respectively, with healthcare assistance. Home hemodialysis monthly costs were €2225 and €4049 in case of healthcare assistance. Discussion. Home-based dialysis modalities, including assisted treatments, demonstrated overall cost competitiveness compared with in-centre hemodialysis. These findings support the potential economic sustainability of expanding home dialysis programs within the healthcare system.