Budget impact of expanded hemodialysis versus high-flux hemodialysis using real-world evidence in Colombia

BACKGROUND: Expanded hemodialysis (HDx) using medium cut-off dialyzers has been associated with lower all-cause hospitalization rates compared to conventional high-flux hemodialysis. Reductions in hospitalization frequency represent a major driver of healthcare expenditures and may contribute to improved budget sustainability in resource-constrained healthcare systems. The objective of this study was to estimate the budget impact of adopting HDx from the perspective of the Colombian healthcare system, using real-world evidence. METHODS: A budget impact analysis was developed according to the ISPOR guidelines using a tool built in Microsoft Excel. Clinical effectiveness inputs were derived from a multicenter cohort study (COREXH-E), including an extended dataset and a difference-in-differences analysis to estimate the effect of HDx on hospitalization rate while accounting for unobserved confounding. Cost inputs were obtained from national administrative databases, including hospitalization costs and bundled dialysis payments. The analysis adopted a one-year time horizon and a third-party payer perspective representing the Colombian healthcare system. Budget impact scenarios were evaluated, assuming HDx market uptake rates of 5%, 10%, 20%, and 50%. Deterministic and probabilistic sensitivity analyses were performed to assess parameter uncertainty. RESULTS: Adoption of HDx was associated with net cost savings for the Colombian healthcare system across all uptake scenarios. Under hospitalization rates observed in the real-world cohort, estimated annual savings ranged from USD 472,756 to USD 4,727,564 as HDx uptake increased from 5% to 50%. In scenarios reflecting higher hospitalization rates observed in the general Colombian hemodialysis population, annual savings ranged from USD 1,344,401 to USD 13,444,010. Cost savings were primarily driven by reductions in hospitalization frequency. Probabilistic sensitivity analysis showed that HDx was cost-saving in 97.8% of simulations. CONCLUSIONS: This study suggests that expanded hemodialysis could result in short-term cost savings for the Colombian healthcare system by reducing hospitalization-related costs without increasing dialysis expenses.