Data_Sheet_1_Is the cost of the new home dialysis techniques still advantageous compared to in-center hemodialysis? An Italian single center analysis and comparison with experiences from western countries.docx

IntroductionPotential advantages of home dialysis remained a questionable issue. Three main factors have to be considered: the progressive reduction in the cost of consumables for in-Center hemodialysis (IC-HD), the widespread use of incremental Peritoneal Dialysis (PD), and the renewed interest in home hemodialysis (H-HD) in the pandemic era. Registries data on prevalence of dialysis modalities generally report widespread underemployment of home dialysis despite PD and H-HD could potentially provide clinical benefits, improve quality of life, and contrast the diffusion of new infection among immunocompromised patients.
MethodsWe examined the economic impact of home dialysis by comparing the direct and indirect costs of PD (53 patients), H-HD (21 patients) and IC-HD (180 patients) in a single hospital of North-west Italy. In order to achieve comparable weekly costs, the average weekly frequency of dialysis sessions based on the dialysis modality was calculated, the cost of individual sessions per patient per week normalized, and the monthly and yearly costs were derived.
ResultsAs expected, PD resulted the least expensive procedure (€ 23,314.79 per patient per year), but, notably, H-HD has a lower average cost than IC-HD (€ 35,535.00 vs. € 40,798.98). A cost analysis of the different dialysis procedures confirms the lower cost of PD, especially continuous ambulatory PD, compared to any extracorporeal technique.
DiscussionAmong the hemodialysis techniques, home bicarbonate HD showed the lowest costs, while the weekly cost of Frequent Home Hemodialysis was found to be comparable to In-Center Bicarbonate Hemodialysis.

引言
居家透析的潜在优势长期以来始终是颇具争议的议题。需考量三大核心因素：中心血液透析（in-Center hemodialysis, IC-HD）耗材成本的持续下降、逐步普及的增量式腹膜透析（Peritoneal Dialysis, PD），以及新冠疫情时代人们对居家血液透析（home hemodialysis, H-HD）重新燃起的关注。透析登记系统中关于各类透析方式患病率的数据普遍显示，尽管腹膜透析与居家血液透析有望带来临床获益、提升患者生活质量，并能降低免疫功能低下人群的新发感染传播风险，但居家透析的整体使用率仍普遍偏低。

方法
本研究以意大利西北部某单中心医院的患者为研究对象，对比腹膜透析（53例）、居家血液透析（21例）与中心血液透析（180例）的直接与间接成本，以此评估居家透析的经济学影响。为确保周成本具备可比性，本研究依据各类透析方式计算了患者每周的平均透析频次，对每位患者每周单次透析的成本进行标准化处理，并由此推导月度与年度总成本。

结果
与预期一致，腹膜透析是成本最低的透析方式（每位患者年成本为23314.79欧元）；值得注意的是，居家血液透析的平均成本低于中心血液透析（分别为35535.00欧元与40798.98欧元）。不同透析方式的成本分析证实，相较于任何体外透析技术，腹膜透析（尤其是持续性不卧床腹膜透析）的成本更低。

讨论
在各类血液透析技术中，居家碳酸氢盐血液透析的成本最低；而频繁居家血液透析的周成本与中心碳酸氢盐血液透析相当。