Cost of Home Dialysis in France

Abstract

Summary

Medico-economic evaluation is defined as economic evaluation applied to the health field. It is a comparative analysis of different diagnostic, therapeutic or preventive strategies, based on their costs and health outcomes. We have only one medico-economic study on the costs of dialysis in France, carried out by the Haute Autorité de Santé, which covered the year 2012 and consisted of cross-referencing 3 databases: the Registre Réseau Épidémiologique et Information en Néphrologie and the Système National d’Informations Inter-régimes de l’Assurance Maladie et de l’Hospitalisation. Analyses focused on prevalent patients, incident patients and key patient characteristics: age, presence of diabetes and care trajectories. The average monthly cost varied considerably according to the management modality, from 3774 euros/month in autonomous continuous ambulatory peritoneal dialysis (CAPD) to 7253 euros/month in center-based hemodialysis. The monthly cost of therapies according to the patient profile appears to be strongly affected by the diabetic status of the patients. This analysis shows the high cost of transport for patients on in-center hemodialysis (20% of total expenditures), and even higher for nursing care in assisted CAPD (37% of total expenditures). The total tariff decreases from 2014 to 2020 were -17.6% for center-based hemodialysis and -9.8% for the low medicalized dialysis unit (LMDU), while the total 2014–2021 tariff increases were +9.3% for CAPD and +9.1% for automated peritoneal dialysis (APD). Paradoxically, these price changes have increased the cost of assisted peritoneal dialysis, which is now almost at the same level of overall cost as in-center hemodialysis for the French health insurance system. The ongoing study of the Physidia Laboratory’s retrospective cohort on daily home hemodialysis (DHH) should allow us to know the current cost of each hemodialysis technique currently practiced in France, including DHH.