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Background: Increasing healthcare expenditures have triggered a trend from volume to value by linking patient outcome to costs. This concept first described as value-based healthcare (VBHC) by Michael Porter is especially applicable for chronic conditions. This article aims to explore the applicability of the VBHC framework to the chronic kidney disease (CKD) care area. Methods: The 4 dimensions of VBHC (measure value; set and communicate value benchmarking; coordinate care; payment to reward value-add) were explored for the CKD care area. Available data was reviewed focusing on CKD initiatives in Europe to assess to what extent each of the 4 dimensions of VBHC have been applied in practice. Results: Translating VBHC into value-based renal care (VBRC) seems to be initiated to a limited extent in European health systems. In most cases not all dimensions of VBHC have been utilized in the renal care initiatives. Conclusion: The translation of VBHC into VBRC is possible and even desirable if an optimal treatment pathway for CKD patients could be achieved. This would require an organizational change in health system set up and should include a strategy focusing on full care responsibility. The patient outcome perspective and health economic analysis need to be the centre of attention.

Objectives: COVID-19 has emphasized the importance of home therapies, especially for dialysis patients requiring a continuous treatment preformed in a clinic given the high infection risk One major barrier for the provider is the economic impact in home hemodialysis (HHD) The study’s objective was to assess the quality and analyze the comprehensiveness of economic studies on HHD Methods: A systematic literature review (SLR) was conducted (February 2020) Publications were excluded with a patient no below 20, multiple baseline therapies and irrelevant comparators or outcomes The critical appraisal was performed using the Drummond checklist (1996) for economic evaluations (EE) and the Molinier checklist (2008) for costs/resources use studies Additionally, an appraisal was performed according to Petrovic et al 2020 to review cost components covered Results: The SLR identified 13 costs/resources use studies and 10 EEs The Molinier checklist highlighted that most studies didn’t discount costs nor tested major assumptions in a sensitivity analysis The Drummond checklist showed a) study design - no study justified choice of EE b) data collection – had the lowest average compliance c) analysis and interpretation of results – only one study provided details of statistical test(s) and confidence intervals The analysis of cost components showed 1) mixture between costs and reimbursement data 2) only one study accounted for patient’s productivity loss and none accounted for family/caregivers 3) none of the studies included costs of setting up a HHD program Conclusions: Most economic studies don’t report on all required criteria defined by the best practice checklists There are no economic studies that reflect all cost components associated with HHD Since reimbursement calculations also rely on accurate economic studies, this could lead to underrepresentation of costs when setting up HHD Uptake of HHD remains low and revised economic studies should be undertaken to increase uptake in the context of COVID-19

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

Background: Professional truck drivers, as other shift workers, have been identified as a high-risk group for various health conditions including cardiovascular disease, obesity, diabetes, sleep apnoea and stress. Mobile health technologies can potentially improve the health and wellbeing of people with a sedentary lifestyle such as truck drivers. Yet, only a few studies on health promotion interventions related to mobile health technologies for truck drivers have been conducted. We aimed to explore professional truck drivers’ views on health promotion delivered via mobile health technologies such as wearable devices. Methods: We conducted a phenomenological qualitative study, consisting of four semi-structured focus groups with 34 full-time professional truck drivers in the UK. The focus groups were audio-taped, transcribed verbatim and analysed using thematic content analysis. We discussed drivers’ perceptions of their health, lifestyle and work environment, and their past experience and expectations from mobile health technologies. Results: The participants viewed their lifestyle as unhealthy and were aware of possible consequences. They expressed the need and wish to change their lifestyle, yet perceived it as an inherent, unavoidable outcome of their occupation. Current health improvement initiatives were not always aligned with their working conditions. The participants were generally willing to use mobile health technologies such as wearable devices, as a preventive measure to avoid prospect morbidity, particularly cardiovascular diseases. They were ambivalent about privacy and the risk of their employer’s monitoring their clinical data. Conclusions: Wearable devices may offer new possibilities for improving the health and wellbeing of truck drivers. Drivers were aware of their unhealthy lifestyle. They were interested in changing their lifestyle and health. Drivers raised concerns regarding being continuously monitored by their employer. Health improvement initiatives should be aligned with the unique working conditions of truck drivers. Future research is needed to examine the impact of wearable devices on improving the health and wellbeing of professional drivers. Published version