Presentation (CTI)

OBJECTIVES: Fluid overload (FO) is a frequent complication among hemodialysis (HD) & hemodiafiltration (HDF) patients. Evidence suggests that the risk of all-cause hospitalization among patients remaining normally hydrated is 30% lower. However, limited evidence exists quantifying the economic impact of FO. Herein, we analyzed the economic burden of FO-related hospitalizations in France, Germany, and Italy from health system and provider perspectives.
METHODS: FO-related hospitalization rates among maintenance HD/HDF patients were derived from a large EMEA real-world study (>70,000 patients). Country-specific DRG tariffs clinically associated with FO (heart failure, pulmonary edema, respiratory failure, and fluid overload) were identified, and a weighted hospitalization tariff was calculated. This was combined with national HD/HDF prevalence and country-specific HDF uptake to estimate hospitalization costs. The length of stay (LOS) of FO-related hospitalization was conservatively assumed equivalent to country-specific all-cause hospitalization LOS. Missed dialysis sessions were calculated, assuming three treatments per week and applying LOS. This was translated into foregone reimbursement using country-specific reimbursement rates by modality and reported for a 100-patient center. One-way sensitivity analyses were conducted.
RESULTS: In a pooled EMEA patient population, FO-related hospitalization rates were: 0.14 (HD) and 0.087 (HDF) per patient-year. For the prevalent HD/HDF population, estimated annual tariff-based hospitalization costs attributable to FO were 20.240.087,03€ (France), 31.165.218,47€ (Germany), and 13.358.082,13€ (Italy). The mean hospitalization LOS was assumed to be 6.7 (France), 8.7 (Germany) and 8.9 (Italy) days; resulting in an estimated annual foregone reimbursement of 10.098,26-10.583,39€ (France); 7.127,88-8.587,97€ (Germany) and 6.402,85 -10.435,89€ (Italy), for a center managing 100 patients.
CONCLUSIONS: While our analysis represents a conservative approach that excludes indirect costs, readmissions, intensive care, and operational burden, it is evident that FO represents a significant and potentially avoidable source of healthcare expenditure and provider burden. Strategies aimed at improving fluid management such as bioimpedance spectroscopy devices may generate meaningful clinical and economic benefits.