Cost savings of home nocturnal versus conventional in-center hemodialysis

✍ Scribed by Mcfarlane, Philip A.; Pierratos, Andreas; Redelmeier, Donald A.

• Publisher: Nature Publishing Group
• Year: 2002
• Tongue: English
• Weight: 72 KB
• Volume: 62
• Category: Article
• ISSN: 0085-2538
• DOI: 10.1046/j.1523-1755.2002.00678.x

✦ Synopsis

Background:

Home nocturnal hemodialysis (hnhd) can improve clinical and biochemical factors in people with renal failure, but its cost-effectiveness relative to conventional in-center hemodialysis (ihd) is uncertain. we hypothesized that hnhd would provide more dialysis treatments at a lower total cost than ihd.

Methods:

A prospective one-year descriptive costing study was performed at two centers in toronto, canada, involving patients enrolled from a hnhd program (n = 33), and a matched cohort from an ihd program (n = 23). all costs are expressed as mean weekly amount in canadian year 2000 dollars. a projected mean annual cost (pma) was calculated also.

Results:

The mean number of treatments per week was much higher with hnhd (5.7 vs. 3.0, p = 0.004). cost categories found to be less expensive for hnhd were staffing (weekly $210 vs. $423, p < 0.001, pma $10,932 vs. $22,056) and overhead and support (weekly $80 vs. $238, p < 0.001, pma $4179 vs. $12,393). there was a trend toward lower costs for hospital admissions and procedures (weekly $23 vs. $134, p = 0.355, pma $1173 vs. $6997) and for medications ($172 vs. $231, p = 0.082, pma $8989 vs. $12,029). costs found to be more expensive for hnhd were the cost of direct hemodialysis materials (weekly $318 vs. $126, p < 0.001, pma $16,587 vs. $6575) and capital costs (weekly $118 vs. $17, p < 0.001, pma $6139 vs. $871), with a trend toward higher cost for laboratory tests (weekly $33 vs. $26, p = 0.094, pma $1744 vs. $1364). physician costs were the same at $128 per week (pma $6650). the weekly mean total cost for health care delivery was 20% less for hnhd ($1082 vs. $1322, p = 0.006), with projected mean annual costs more than $10,000 lower ($56,394 vs. $68,935).

Conclusions:

Hnhd provides about three times as many treatment hours at nearly a one-fifth lower cost, with savings evident even when only program and funding-specific costs are considered.