• Expanded hemodialysis (HDx) was associated with lower resource consumption and lower costs compared with online hemodiafiltration (OL-HDF) from a provider perspective in Spain. • HDx generated consistent cost savings per session (euro2.7– euro6.6), mainly due to reduced consumables and lower water use. • In probabilistic sensitivity analyses, HDx was the dominant strategy in 90% of simulations, with mean annual savings of euro428 per patient. • HDx required approximately 20% less water per session than OL-HDF (120 vs 150 L), resulting in substantial cumulative water savings over time. • These findings support HDx as a cost-efficient and environmentally sustainable dialysis modality without additional infrastructure requirements. Introduction: Expanded hemodialysis (HDx) utilizing medium-cut-off membranes has emerged as a viable alternative to online hemodiafiltration (OL-HDF). HDx offers comparable removal of middle molecules and does not necessitate replacement fluids or supplementary infrastructure. This study focuses on the operating costs of the two modalities and assesses some of the economic and environmental implications of HDx in comparison to OL-HDF, in particular water consumption. Methods: A micro-costing analysis was conducted from the perspective of a healthcare provider in Spain. Resource utilization per HDx and OL-HDF session was quantified, and unit costs were derived from administrative records and expressed in euros for the year 2024. Deterministic and probabilistic sensitivity analyses were conducted to examine variability in costs and water consumption. Results: In the base case, HDx was associated with net savings of euro2.7 per session compared to OL-HDF. This was mainly due to the elimination of the OL-HDF substitution line requirement and lower water use. Across various sensitivity scenarios, savings ranged from euro2.70 to euro6.60 per session. The probabilistic analysis indicated that HDx was the dominant strategy in 90% of 1,000 simulations, resulting in annual savings of about euro428 per patient-year. Regarding environmental impact, HDx had a water consumption of 120 liters per session, versus 150 liters for OL-HDF. Over five years, a group of 1,000 patients treated with HDx would save approximately 23.4 million liters of water. Conclusions: HDx with Theranova offers lower resource use and lower costs compared to OL-HDF by reducing the need for specific consumables other than the dialyzer and for water consumption. These findings support the potential benefit of HDx as an efficient dialysis modality that responsibly uses the planet's resources.
Rivera et al. (Sun,) studied this question.