Value of an Integrated Home Dialysis Model in the United Kingdom: A Cost-Effectiveness Analysis

Erbe, Amanda W.; Busink, Ellen; Carroll, Suzanne J.; Aas, Eline

doi:10.1016/j.jval.2023.02.009

Cited by 4 publications

(4 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…While no study has directly compared the cost effectiveness of a PD-to-HHD transition with a ‘HHD only’ approach, the known cost advantage of PD compared to facility HD and HHD allows us to hypothesize that the integrated approach is more cost-effective [ 32 ]. By contrast, a British study has compared the costs of a PD-to-HHD transition with the ones of PD-to-facility HD [ 109 ]. Although the PD-to-HHD transition was not shown to be cost-effective overall (additional cost of £46 920 per QALY), this finding was explained by the increased healthcare costs of enhanced survival in HHD, and secondary analyses restricted to dialysis costs revealed a financial advantage to the integrated home dialysis paradigm.…”

Section: First Results and Clinical Outcomesmentioning

confidence: 99%

Integrated home dialysis model: facilitating home-to-home transition

Desbiens,

Bargman,

Chan

et al. 2024

Clinical Kidney Journal

View full text Add to dashboard Cite

Peritoneal dialysis (PD) and home hemodialysis (HHD) are the two home dialysis modalities offered to patients. They promote patient autonomy, enhance independence, and are generally associated with better quality of life compared to facility hemodialysis. PD offers some advantages (enhanced flexibility, ability to travel, preservation of residual kidney function, and vascular access sites) but few patients remain on PD indefinitely due to peritonitis and other complications. By contrast, HHD incurs longer and more intensive training combined with increased upfront health costs compared to PD, but is easier to sustain in the long term. As a result, the integrated home dialysis model was proposed to combine the advantages of both home-based dialysis modalities. In this paradigm, patients are encouraged to initiate dialysis on PD and transfer to HHD after PD termination. Available evidence demonstrates the feasibility and safety of this approach and some observational studies have shown that patients who undergo the PD-to-HHD transition have clinical outcomes comparable to patients who initiate dialysis directly on HHD. Nevertheless, the prevalence of PD-to-HHD transfers remains low, reflecting the multiple barriers that prevent the full uptake of home-to-home transitions, notably a lack of awareness about the model, home-care “burnout,” clinical inertia after a transfer to facility HD, suboptimal integration of PD and HHD centers, and insufficient funding for home dialysis programs. In this review, we will examine the conceptual advantages and disadvantages of integrated home dialysis, present the evidence that underlies it, identify challenges that prevent its success and finally, propose solutions to increase its adoption.

show abstract

Section: First Results and Clinical Outcomesmentioning

confidence: 99%

Integrated home dialysis model: facilitating home-to-home transition

Desbiens,

Bargman,

Chan

et al. 2024

Clinical Kidney Journal

View full text Add to dashboard Cite

show abstract

Section: Historic Trends In Use Of Home Dialysismentioning

confidence: 99%

“…The economic data underlying home HD treatments are less clear, but there is some evidence that the modality may be cost-effective in aggregate because of reduced hospitalizations and improved clinical outcomes. [16][17][18] Two years after implementing the bundled payment expansion, use of PD within the first 90 days of starting dialysis had increased from 9.4% to 12.6% and treatment with PD after the first 90 days through 2 years from 12.1% to 16.1%. 19,20 US Food and Drug Administration approval of the NxStage System One in 2005 was also an inflection point for uptake of home HD (Figure 1).…”

Section: Historic Trends In Use Of Home Dialysismentioning

confidence: 99%

System-Level Strategies to Improve Home Dialysis

Watnick,

Blake,

Mehrotra

et al. 2023

CJASN

View full text Add to dashboard Cite

Advocacy and policy change are powerful levers to improve quality of care and better support patients on home dialysis. While the kidney community increasingly recognizes the value of home dialysis as an option for patients who prioritize independence and flexibility, only a minority of patients dialyze at home in the United States. Complex system-level factors have restricted further growth in home dialysis modalities, including limited infrastructure, insufficient staff for patient education and training, patient-specific barriers, and suboptimal physician expertise. In this article, we outline trends in home dialysis use, review our evolving understanding of what constitutes high quality care for the home dialysis population (as well as how this can be measured), and discuss policy and advocacy efforts that continue to shape the care of US patients, and compare with experiences in other countries. We conclude by discussing future directions for quality and advocacy efforts.

show abstract

“…Studies dealing with the economic impact of dialysis techniques indicate that home dialysis costs for either HHD or PD can be as high as in facility-based hemodialysis, as the initial implementation of HHD at the patient's home is costly [ 4 ], as are PD consumables, especially automatic PD. Nevertheless, US studies have revealed that the more time HHD patients are maintained at home, the more money is saved [ 5 ].…”

mentioning

confidence: 99%