Background:
Home nocturnal hemodialysis is an intensive form of hemodialysis, where patients perform their treatments at home for about 7 hours approximately 6 nights a week. compared with in-center conventional hemodialysis, home nocturnal hemodialysis has been shown to improve physiologic parameters and reduce health care costs; however, the effects on quality of life and cost utility are less clear. we hypothesized that individuals performing home nocturnal hemodialysis would have a higher quality of life and superior cost utility than in-center hemodialysis patients.
Methods:
Home nocturnal hemodialysis patients and a demographically similar group of in-center hemodialysis patients from a hospital without a home hemodialysis program underwent computer-assisted interviews to assess their utility score for current health by the standard gamble method.
Results:
Nineteen in-center hemodialysis and 24 home nocturnal hemodialysis patients were interviewed. mean annual costs for home nocturnal hemodialysis were about 10,000 dollars lower for home nocturnal hemodialysis (55,139 dollars +/- 7651 dollars for home nocturnal hemodialysis vs. 66,367 dollars +/- 17,502 dollars for in-center hemodialysis, p = 0.03). home nocturnal hemodialysis was associated with a higher utility score than in-center hemodialysis (0.77 +/- 0.23 vs. 0.53 +/- 0.35, p = 0.03). the cost utility for home nocturnal hemodialysis was 71,443 dollars/quality-adjusted life-year (qaly), while for in-center hemodialysis it was 125,845 dollars/qaly. home nocturnal hemodialysis was the dominant strategy, with an incremental cost-effectiveness ratio (icer) of -45,932 dollars. the 95% ci for the icer, and 2500 bootstrap iterations of the icer all fell below the cost-effectiveness ceiling of 50,000 dollars. the net monetary benefit of home nocturnal hemodialysis ranged from 11,227 dollars to 35,669 dollars.
Conclusion:
Home nocturnal hemodialysis is associated with a higher quality of life and a superior cost utility when compared to in-center hemodialysis.