Direct Public-Payer Costs of Dialysis Therapies in Greece: A Patient-Level Micro-Costing Study Across Modality and Provider Sector

Background: Dialysis is a life-sustaining but resource-intensive treatment for patients with kidney failure. Contemporary Greek evidence on the public-payer cost of dialysis is limited, particularly for comparisons across modality, provider sector and treatment subtype. Methods: We performed a retrospective observational micro-costing study using 2022 patient-level data from five hemodialysis units and one peritoneal dialysis unit in Greece. The perspective was that of the public payer and public health budget. Annual costs included dialysis treatment and consumables, patient allowances and transport reimbursement, dialysis-related drugs, laboratory and imaging tests, hospitalizations and public dialysis-unit operating costs where applicable. Results: The analytic sample included 359 patients: 337 receiving hemodialysis and 22 receiving peritoneal dialysis. Median annual total cost was EUR 35,902.53 for hemodialysis and EUR 57,136.44 for peritoneal dialysis per patient. Peritoneal dialysis generated higher annual cost than hemodialysis, mainly because of treatment and consumable costs, and remained more costly after excluding dialysis-unit operating costs in sensitivity analysis. Public-sector hemodialysis had higher recorded median annual public-payer/public-budget cost than private-sector hemodialysis (EUR 38,794.55 versus EUR 34,836.98), but this difference was no longer statistically significant after excluding dialysis-unit operating costs. Hemodiafiltration was more costly than conventional hemodialysis, and automated peritoneal dialysis was more costly than continuous ambulatory peritoneal dialysis. National extrapolation estimated annual public expenditure of EUR 466.6 million using mean costs and EUR 446.8 million using median-based sensitivity estimates. Conclusions: Dialysis imposes substantial annual public expenditure in Greece. In this dataset and reimbursement context, peritoneal dialysis was more costly than hemodialysis, while private-sector hemodialysis generated lower recorded public-payer cost than public-sector provision. The apparent public–private hemodialysis cost difference was sensitive to the treatment of operating costs. These results may help inform reimbursement review, procurement policy and future budget-impact analyses of dialysis service redesign.