# Hospital-based health technology assessment of central dialysis fluid delivery system for hemodialysis patients

## TL;DR

This study shows that a central dialysis system saves costs more as dialysis centers grow larger, making it a good investment for bigger facilities.

## Contribution

The study provides hospital-specific economic evidence for adopting central dialysis systems in medium- to large-scale dialysis centers.

## Key findings

- CDDS reduced costs by 0.05% in small centers and up to 21.08% in larger centers with 50 machines.
- Cost savings in a 50-machine center reached RMB 2.6 million annually, mainly from lower consumable and labor costs.
- Sensitivity analysis confirmed the robustness of CDDS cost savings across different scenarios.

## Abstract

This study employed a hospital-based health technology assessment (HB-HTA) to evaluate the economic value of the central dialysis fluid delivery system (CDDS) compared to the single-patient dialysis fluid delivery system (SPDDS) in hemodialysis. The findings offer evidence to support hospital procurement and clinical implementation decisions regarding CDDS.

A comparative cost analysis was conducted using micro-costing data collected from three hospitals. Costs were estimated for both CDDS and SPDDS, and economic efficiency was evaluated across multiple hemodialysis machine configuration scales. The analysis included total costs, cost structures, and cost savings, along with their constituent components, to identify scenarios in which CDDS provides economic advantages.

In a dialysis center with 6 hemodialysis machines operating two shifts per day and serving 12 patients daily, CDDS reduced costs by 0.05% compared to SPDDS. As the number of machines increased from 6 to 50, the cost reduction rate rose from 0.05% to 21.08%, demonstrating enhanced economic benefits at larger scales. In a 50-machine center, CDDS saved approximately RMB 84 per treatment session and RMB 2,601,108 annually. The majority of cost savings came from reductions in consumables (74%) and labor (24%). One-way sensitivity analysis confirmed that CDDS consistently yielded cost savings, supporting the robustness of the costing model.

CDDS demonstrates significant economic value over SPDDS by reducing consumable and labor costs, proving to be a cost-effective solution in dialysis centers with 6 or more machines serving at least 12 patients daily. Clinical engineers play a key role in its implementation. CDDS is suitable for promotion in medium- to large-scale dialysis centers in China.

The online version contains supplementary material available at 10.1186/s12882-025-04484-7.