Health Technology Assessment of a new water quality monitoring technology: Impact of automation, digitalization and remoteness in dialysis units

PLoS One. 2021 Feb 25;16(2):e0247450. doi: 10.1371/journal.pone.0247450. eCollection 2021.

Abstract

Background: Water quality monitoring at the dialysis units (DU) is essential to ensure an appropriate dialysis fluid quality and guarantee an optimal and safe dialysis treatment to patients. This paper aims to evaluate the effectiveness, economic and organizational impact of automation, digitalization and remote water quality monitoring, through a New Water Technology (NWT) at a hospital DU to produce dialysis water, compared to a Conventional Water Technology (CWT).

Methods: A before-and-after study was carried out at the Hospital Clínic Barcelona. Data on CWT was collected during 1-year (control) and 7-month for the NWT (case). Data on water quality, resource use and unit cost were retrospective and prospectively collected. A comparative effectiveness analysis on the compliance rate of quality water parameters with the international guidelines between the NWT and the CWT was conducted. This was followed by a cost-minimization analysis and an organizational impact from the hospital perspective. An extensive deterministic sensitivity analysis was also performed.

Results: The NWT compared to the CWT showed no differences on effectiveness measured as the compliance rate on international requirements on water quality (100% vs. 100%), but the NWT yielded savings of 3,599 EUR/year compared to the CWT. The NWT offered more data accuracy (daily measures: 6 vs. 1 and missing data: 0 vs. 20 days/year), optimization of the DU employees' workload (attendance to DU: 4 vs. 19 days/month) and workflow, through the remote and continuous monitoring, reliability of data and process regarding audits for quality control.

Conclusions: While the compliance of international recommendations on continuous monitoring was performed with the CWT, the NWT was efficient compared to the CWT, mainly due to the travel time needed by the technical operator to attend the DU. These results were scalable to other economic contexts. Nonetheless, they should be taken with caution either when the NWT equipment/maintenance cost are largely increased, or the workforce involvement is diminished.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Automation / standards*
  • Cost-Benefit Analysis
  • Dialysis Solutions / standards*
  • Female
  • Health Services / standards*
  • Humans
  • Male
  • Middle Aged
  • Prospective Studies
  • Renal Dialysis / standards*
  • Reproducibility of Results
  • Retrospective Studies
  • Technology Assessment, Biomedical / methods*
  • Water / standards*
  • Water Quality / standards*

Substances

  • Dialysis Solutions
  • Water

Grants and funding

Fresenius Medical Care (FMC) has co-financed the present study. No authors have directly received the project grant; the institution which the authors work for (Hospital Clínic Barcelona) is the one that received the project grant instead. BGL, CFB, FM, LSC reports grants from FMC during the conduct of the study. BGL reports conferences fees and expenses from FMC during the conduct of the study. FM reports personal fees from FMC during the conduct of the study. The funders had no role in study design, analysis or decision to publish. FMC had role in the data collection and reviewing the final version of the manuscript.