Economic Evaluation of Frequent Home Nocturnal Hemodialysis Based on a Randomized Controlled Trial

Abstract

Provider and patient enthusiasm for frequent home nocturnal hemodialysis (FHNHD) has been renewed; however, the cost-effectiveness of this technique is unknown. We performed a cost-utility analysis of FHNHD compared with conventional hemodialysis (CvHD; 4 hours three times per week) from a health payer perspective over a lifetime horizon using patient information from the Alberta NHD randomized controlled trial. Costs, including training costs, were obtained using microcosting and administrative data (CAN$2012). We determined the incremental cost per quality-adjusted life year (QALY) gained. Robustness was assessed using scenario, sensitivity, and probabilistic sensitivity analyses. Compared with CvHD (61% in-center, 14% satellite, and 25% home dialysis), FHNHD led to incremental cost savings (2$6700) and an additional 0.38 QALYs. In sensitivity analyses, when the annual probability of technique failure with FHNHD increased from 7.6% (reference case) to $19%, FHNHD became unattractive

Estimating patient-borne water and electricity costs in home hemodialysis: a simulation

“…6,[8][9][10][11][12][13][14] The annual utility cost of home hemodialysis in Edmonton in this study ranges from $420 to $1269. Not surprisingly, the most expensive form of dialysis is a prescription used for 8-hour 6-times-weekly nocturnal hemodialysis and the least expensive is for a prescription of conventional 4-hour thrice-weekly hemodialysis.…”

“…[1][2][3][4][5] This modality also results in cost savings to the health care system when compared with incentre intermittent hemodialysis. [6][7][8] Existing economic analyses have looked at the costs of providing this therapy solely from the payer perspective. Although there is considerable variability in analytic approaches and their results, it is generally accepted that home hemodialysis is associated with fewer human resources and lower facility management expenses.…”

“…Although there is considerable variability in analytic approaches and their results, it is generally accepted that home hemodialysis is associated with fewer human resources and lower facility management expenses. [6][7][8][9][10][11][12][13][14] However, when patients self-dialyze at home, some expenses (such as the utility costs of running the dialysis equipment) are transferred to the patient. The aim of this study was to measure utility consumption (water and electricity) required to perform various prescriptions of home hemodialysis, and estimate the associated costs.…”

What can be achieved by redesigning stroke care for a value-based world?

“…Savings for stroke care & improved healthcare outcomes When we look for innovations in care delivery that have succeeded in combining upstream interventions to prevent risk factor progression, they have often been used by physician groups that bear financial risk such as Permanente's hypertension intervention program in the US [9] or government-run programs outside the US [10].…”

“…These innovations have already demonstrated cost savings in multiple disease states such as moving from outpatient to home dialysis for end-stage renal disease patients [10] or earlier addition of palliative care services for oncologic patients [11].…”