#2310 Economic and societal benefits of teledialysis in ASL Lecce, Italy
Authors: Zito Anna , Prete Daniele , De Pascalis Antonio , Ria Paolo , Fonto Giulia , Protopapa Paolo , Barbarini Silvia , Elia Gianluca , Napoli Marcello 
Published: May 2024

Abstract

Background and Aims
The number of patients in chronic hemodialysis with a high demand for socio-economic resources is growing worldwide. Home HemoDialysis (HHD), particularly when aided by Information Technology, may help in decreasing unnecessary travels, reducing costs and promoting the active role of patient and caregiver. Nevertheless, it remains significantly underused (Europe: &lt;2% of dialysis patients).
The inability or unwillingness of patients and their families to participate in their own treatment is one of the most important barriers to HHD. It is already known that HHD delivered by a paid caregiver and supported by public funds is well accepted by patients. As a step forward, we decided to combine assisted HHD with teledialysis (TD) to encourage patients to transition towards self-assisted HHD.
Since 2018, our Department has been providing HHD with the assistance of Personal Support Workers (PSW). In 2023, a TD platform was built, to promote the empowerment and incorporate patients in HHD into the daily management at the central institution.
Herein we present a preliminary economic analyses to determine the direct and indirect cost savings of HHD, implemented with TD, compared to in-person care.

Method
Currently, in the ASL Lecce, the Regional Health System of the province of Lecce, Puglia, Italy, 800 patients undergo haemodialytic treatment. A telehealth hub&spoke model of dialysis care across a distributed network was created to connect facilities within the hospital, satellite dialysis units, and patients receiving HHD.
The HHD program started in June 1st, 2018; since then, 123 patients have been treated. During pandemic restrictions, HHD provided an effective renal care model for 39 patients with COVID-19.
On 1st September 2023, the 29 patients receiving HHD were involved in the telemedicine-assisted dialysis model that was implemented on a tender basis (clinical-demographic data in Table 1).
The TD platform is intended as a set of infrastructural, software and hardware components functional for continuous monitoring dialysis treatments, as depicted in Fig. 1, requiring the availability of real-time consultations with nephrologists.

Results
We report the costs related to self-assisted HHD, PSW-assisted HHD and TD programs as awarded in the call for tender. The overall costs of the TD platform are listed in Table 2.
In Table 3 the effective costs, indicated as direct (in center hemodialysis or HHD) and indirect (mainly travels, only for in-center hemodialysis), are reported.
As a consequence, the TD program will allow to save the annual costs related to transport as follows:
A similar evaluation may be proposed for all in-center dialytic techniques compared to HHD plus TD service.

Conclusion
Given the growing need for economic and environmental sustainability, the expected savings related to a higher numbers of patients attracted to HHD, particularly self-assisted, are noteworthy.
Since patients involved in TD program are mostly elderly and suffer from multiple comorbidities, the high cost of the TD-assisted modalities may be justified by the reduced complications and hospitalizations and the promotion of the patient empowerment.
At the end of a 5-years period, a cost-minimization analysis of the project will be performed to investigate on the effective utility of TD in increasing the number of HHD eligible patients and ameliorating the overall quality of life.