OBJECTIVES: COVID-19 has emphasized the importance of home therapies, especially for dialysis patients requiring a continuous treatment preformed in a clinic given the high infection risk. One major barrier for the provider is the economic impact in home hemodialysis (HHD). The study’s objective was to assess the quality and analyze the comprehensiveness of economic studies on HHD.

METHODS: A systematic literature review (SLR) was conducted (February 2020). Publications were excluded with a patient no. below 20, multiple baseline therapies and irrelevant comparators or outcomes. The critical appraisal was performed using the Drummond checklist (1996) for economic evaluations (EE) and the Molinier checklist (2008) for costs/resources use studies. Additionally, an appraisal was performed according to Petrovic et al 2020 to review cost components covered.

RESULTS: The SLR identified 13 costs/resources use studies and 10 EEs. The Molinier checklist highlighted that most studies didn’t discount costs nor tested major assumptions in a sensitivity analysis. The Drummond checklist showed a) study design - no study justified choice of EE b) data collection – had the lowest average compliance c) analysis and interpretation of results – only one study provided details of statistical test(s) and confidence intervals. The analysis of cost components showed 1) mixture between costs and reimbursement data 2) only one study accounted for patient’s productivity loss and none accounted for family/caregivers 3) none of the studies included costs of setting up a HHD program.

CONCLUSIONS: Most economic studies don’t report on all required criteria defined by the best practice checklists. There are no economic studies that reflect all cost components associated with HHD. Since reimbursement calculations also rely on accurate economic studies, this could lead to underrepresentation of costs when setting up HHD. Uptake of HHD remains low and revised economic studies should be undertaken to increase uptake in the context of COVID-19.