PUK20 Reimbursement Landscape in Europe As Hurdle or Accelerator of HOME Hemodialysis in COVID-19 Times

Objectives: Home therapies including Home Hemodialysis (HHD) are a priority on the policy agenda due to COVID-19 This study aims to evaluate the reimbursement landscape for HHD in Europe as a potential hurdle or accelerator to increase access to this therapy Methods: A systematic analysis of reimbursement schemes for HHD was performed in Europe (31 countries), according to 3 criteria: 1) existence of HHD reimbursement 2) HHD reimbursement level independently calculated 3) financially incentivized treatment schedule (FITS) Consequently, countries were matched with the uptake of HHD based on the ERA-EDTA registry and clustered according to these criteria Results: Of the 31 countries, 16 have a HHD reimbursement in place, of those 10 are independently calculated and had a FITS in place Unfortunately, not all countries included in the reimbursement analysis report into the ERA-EDTA registry For the countries meeting criteria 1 the average uptake of HHD was 0 9% (3 out of 6 countries) and for those meeting criteria 2/3 the average was 1 4% (8 out of 10 countries) Conclusions: The above results show that a limited number of countries have HHD reimbursement in place, which is the first hurdle to initiate treatment The countries that do have a reimbursement in place remain to have a low uptake irrespective of FITS Several reasons can underly this including;1) too low reimbursement level, which was excluded from this analysis, 2) hidden costs for HHD exist that are not reflected in the reimbursement 3) education of patients, healthcare staff and system is lacking Additionally, underreporting of HHD data in the ERA-EDTA registry could lead to misleading conclusions Therefore, our recommendation is to initiate best practice exchange and perform a micro-costing analysis for setting up a HHD program as a first step to increase uptake