Chronic Disease Research Group, Hennepin Health Research Institute, Minneapolis, MN; Department of Pharmaceutical Care and Health Systems, University of Minnesota, Minneapolis, MN.
Adv Chronic Kidney Dis. 2021 Mar;28(2):136-142. doi: 10.1053/j.ackd.2021.06.010.
Home hemodialysis (HD) is growing in the United States, but the economics of the modality are largely unknown, especially considering the unique aspects of home HD in the United States . In this review, I focus on details of Medicare coverage, which directly applies to most patients on dialysis and influences the policies of private insurers. Key details in Medicare comprise the relationship between home dialysis training and initial Medicare eligibility, reimbursement for home HD training, coverage of additional HD treatments (ie., in excess of 3 treatments per week), and monthly capitated payments to nephrologists. The overarching narrative is that frequent home HD directly increases Medicare costs for outpatient dialysis, but these added costs can be mitigated by lower inpatient expenditures if increased HD treatment frequency lowers the risk of cardiovascular hospitalization and infection control is emphasized. I also review recent international literature; conventional home HD exhibits a superior cost profile, whereas frequent home HD is generally cost-effective over multiple treatment years (ie, if early technique failure is avoided). Out-of-pocket expenses for patients should be considered. The future economics of home HD in the United States will be determined by new equipment, new adaptations of the modality, and new payment models.
家庭血液透析（HD）在美国不断发展，但该治疗模式的经济学情况在很大程度上尚不清楚，尤其是考虑到美国家庭 HD 的独特方面。在这篇综述中，我重点介绍医疗保险覆盖范围的细节，这直接适用于大多数透析患者，并影响私人保险公司的政策。医疗保险的关键细节包括家庭透析培训与初始医疗保险资格之间的关系、家庭 HD 培训的报销、额外 HD 治疗（即每周超过 3 次治疗）的覆盖范围，以及每月向肾脏病医生的统包支付。总体来说，频繁的家庭 HD 会直接增加门诊透析的医疗保险成本，但如果增加 HD 治疗频率降低了心血管住院风险并强调感染控制，那么这些额外的成本可以通过降低住院支出得到缓解。我还回顾了最近的国际文献；传统的家庭 HD 表现出更优的成本状况，而频繁的家庭 HD 在多个治疗年度内通常具有成本效益（即，如果避免早期技术失败）。还应考虑患者的自付费用。美国家庭 HD 的未来经济学将取决于新设备、该模式的新适应性和新的支付模式。
