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Clinical trials and registry data suggest that HDF improves patient outcomes. Despite the acknowledged need to improve survival rates of dialysis patients and the survival benefit HDF offers, there is little to no utilization in some countries (such as the US) in prescribing HDF to their patients. In this analysis, we present the healthcare value\u2010based case for HDF (relative to HF\u2010HD) from the patient, provider, and payor perspectives. The improved survival and reduced morbidity observed in studies conducted outside the US, as well as the reduced hospitalization, are attractive for each stakeholder. We also consider the potential barriers to greater utilization of HDF therapies, including unfounded concerns regarding additional costs of HDF, e.g., for the preparation and microbial testing of quality of substitution fluids. Ultrapure fluids are easily attainable and prepared from dialysis fluids using established \u201conline\u201c (OL) technologies. OL\u2010HDF has matured to a level whereby little additional effort is required to safely implement it as all modern machine systems are today equipped with the OL\u2010HDF functionality. Countries already convinced of the advantages of HF\u2010HD are thus well positioned to make the transition to OL\u2010HDF to achieve further clinical and associated economic benefits. Healthcare systems struggling to cope with the increasing demand for HD therapies would therefore, like patients, be beneficiaries in the long term with increased usage of OL\u2010HDF for end stage kidney disease patients.<\/jats:p>","DOI":"10.1111\/sdi.13075","type":"journal-article","created":{"date-parts":[[2022,3,18]],"date-time":"2022-03-18T04:41:21Z","timestamp":1647578481000},"page":"405-412","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Switching from high\u2010flux dialysis to hemodiafiltration: Cost\u2010consequences for patients, providers, and payers"],"prefix":"10.1111","volume":"35","author":[{"given":"Carsten","family":"Hornig","sequence":"first","affiliation":[{"name":"Department of Health Economics and Market Access Fresenius Medical Care Deutschland GmbH  Bad Homburg Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christian","family":"Apel","sequence":"additional","affiliation":[{"name":"Department of Health Economics and Market Access Fresenius Medical Care Deutschland GmbH  Bad Homburg Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Linda H.","family":"Ficociello","sequence":"additional","affiliation":[{"name":"Global Medical Office Fresenius Medical Care  Waltham Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dana","family":"Kendzia","sequence":"additional","affiliation":[{"name":"Department of Health Economics and Market Access Fresenius Medical Care Deutschland GmbH  Bad Homburg Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0984-4544","authenticated-orcid":false,"given":"Michael","family":"Anger","sequence":"additional","affiliation":[{"name":"Global Medical Office Fresenius Medical Care  Waltham Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sudhir K.","family":"Bowry","sequence":"additional","affiliation":[{"name":"Dialysis\u2010at\u2010Crossroads (D@X) Advisory  Bad Nauheim Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2022,3,17]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(21)00519-5"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)31694-5"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1159\/000514550"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41581-020-0315-4"},{"key":"e_1_2_6_6_1","first-page":"411","article-title":"USRDS 2018 annual data report: Atlas of end\u2010stage renal disease in the United States, Chapter 5: Mortality","volume":"2","author":"United States Renal Data S","year":"2019","journal-title":"Am J Kidney Dis"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.2011111094"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-017-2764-4"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1038\/sj.ki.5000186"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1159\/000345179"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12882-019-1527-3"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gft396"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa021583"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfp626"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1159\/000110574"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1525-139X.2009.00665.x"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.MAT.0000085985.34472.91"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.ackd.2007.04.002"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfm022"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.1159\/000333627"},{"key":"e_1_2_6_21_1","doi-asserted-by":"publisher","DOI":"10.1159\/000345175"},{"key":"e_1_2_6_22_1","doi-asserted-by":"publisher","DOI":"10.1159\/000346379"},{"key":"e_1_2_6_23_1","doi-asserted-by":"publisher","DOI":"10.1159\/000450634"},{"key":"e_1_2_6_24_1","doi-asserted-by":"publisher","DOI":"10.1038\/ki.2015.264"},{"key":"e_1_2_6_25_1","doi-asserted-by":"publisher","DOI":"10.5301\/ijao.5000414"},{"key":"e_1_2_6_26_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2019-033228"},{"key":"e_1_2_6_27_1","doi-asserted-by":"publisher","DOI":"10.1111\/sdi.13039"},{"key":"e_1_2_6_28_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0b013e31818a43af"},{"key":"e_1_2_6_29_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp0904131"},{"key":"e_1_2_6_30_1","unstructured":"NEJM Catalyst.What Is Value\u2010Based Healthcare?.2017. 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