#2682 Real costs of daily home hemodialysis compared to in-center hemodialysis in France

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Abstract Background and Aims Home hemodialysis (HD) offers several advantages over conventional in-center 3-times-weekly HD, with better preservation of health-related quality of life and treatment flexibility, but its true costs are poorly understood. We therefore aimed to compare the real costs of daily home hemodialysis versus in-center hemodialysis in France. Method Design: National, population-based, cohort study with propensity score matching (PSM) to mitigate selection bias on patient profiles. Setting Individual healthcare data from the French National Health Data System for patients with end-stage kidney disease undergoing dialysis cross-referenced with the French National Cost Scale of the health ministry. Participants A total of 72 358 patients receiving HD were identified and their data collected for the 24-month inclusion period, from January 2016 to December 2017. After exclusion of patients treated < 90 days, and those without a treatment schedule or incomplete data for a social disadvantage score, 42 605 patients were selected (28 317 prevalent and 14 288 incident HD patients). After PSM, 265 incident patients (in-center HD, n = 212; daily home HD, n = 53) and 765 prevalent patients (in-center HD, n = 612; daily home HD, n = 153) were analyzed. Main outcome and measure Global costs of in-center versus daily home HD for incident and prevalent patients after PSM. Results The global cost of daily home HD for incident patients was lower than in-center HD (€1403/week vs. €1652/week, respectively), resulting in annual costs of €72 956 vs. €85 904, respectively. We found similarly lower costs for prevalent patients (€1360/week vs. €1456/week, respectively). For daily home HD, 55% of the costs were directly related to patient renal care compared with 30% for in-center HD. Conversely, in-center HD allocated a larger proportion to transportation (18% (in-center HD) vs. 2% (daily home HD)), and hospitalization (16% (in-center HD) vs. 6% (daily home HD)). Conclusion Daily home HD is a more cost-effective and patient-centered treatment option than in-center HD.

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