An operating cost comparison between conventional and home quotidian hemodialysis

doi:10.1016/S0272-6386(03)00538-9

American Journal of Kidney Diseases

Volume 42, Supplement 1, July 2003, Pages 49-55

https://doi.org/10.1016/S0272-6386(03)00538-9 Get rights and content

Abstract

Background:

Although several studies have shown that simulated annual direct health care costs are substantially lower for patients undergoing more frequent hemodialysis (HD), there is limited information about the economics of daily HD and nocturnal HD.

Methods:

The London Daily/Nocturnal Hemodialysis Study compared the economics of short daily HD (n = 10), long nocturnal HD (n = 12), and conventional thrice-weekly HD (n = 22) in patients over 18 months. A retrospective analysis of patients’ conventional HD costs during the 12 months before study entry was conducted to measure the change in cost after switching to quotidian HD.

Results:

As the data show, annual costs (in Canadian dollars) for daily HD are substantially lower than for both nocturnal HD and conventional HD: approximately Can $67,300, Can $74,400, and Can $72,700 per patient, respectively. Moreover, marginal changes in operating cost per patient year were − Can $9,800, −Can $17,400, and +Can $3,100 for the daily HD, nocturnal HD, and conventional HD groups. Because of the increase in number of treatments, treatment supply costs per patient for the daily HD and nocturnal HD study groups were approximately twice those for conventional HD patients. However, average costs for consults, hospitalization days, emergency room visits, and laboratory tests for quotidian HD patients tended to decline after study entry. The major cost saving in home quotidian HD derived from the reduction in direct nursing time, excluding patient training. Total annualized cost per quality-adjusted life-year for the daily HD and nocturnal HD groups were Can $85,442 and Can $120,903, which represented a marginal change of − Can $15,090 and −Can $21,651, respectively, reflecting both improved quality of life and reduced costs for quotidian HD patients.

Conclusion:

Substantial clinical benefits of home quotidian HD, combined with the economic advantage shown by this study, clearly justify its expansion.

Section snippets

Methods

Ten daily HD, 12 nocturnal HD, and 22 conventional thrice-weekly HD patients were enrolled in the 18-month study.10 The patient who switched from nocturnal HD to daily HD therapy was considered a nocturnal HD patient for this analysis. Conventional HD patients served as matched controls for quotidian HD patients, and a 12-month retrospective chart review allowed each patient to serve as his or her own control. Because of the small number of patients involved, it was hypothesized that using

Results

Table 1 lists the number of weeks that patients were enrolled in both the study and the retrospective analysis. This study represents approximately 105 patient-years of economic data. Variances between groups were caused by deaths, transplantations, and transfers between HD modalities. Subsequent results show that this study, with its relatively small sample size, was clearly underpowered to detect costing differences of statistical significance.

Discussion

The London Daily/Nocturnal Hemodialysis Study is the most comprehensive comparative analysis of costs associated with home quotidian HD to date. As the data show, annual costs for daily HD are substantially less than those for both nocturnal and conventional HD: approximately Can $67,300, Can $74,400, and Can $72,700 per patient, respectively. Annualized QALY values of 0.84, 0.70, and 0.71 for the 3 groups resulted in total annualized cost per QALY of Can $85,400, Can $120,900, and Can

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^☆: The London Daily/Nocturnal Dialysis Study was totally financed by a grant from the Ministry of Health and Long-Term Care of the Province of Ontario, Canada. The publication of this supplement was supported by grants from the Ministry of Health and Fresenius Medical Care of North America.

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An operating cost comparison between conventional and home quotidian hemodialysis☆

Abstract

Background:

Methods:

Results:

Conclusion:

Section snippets

Methods

Results

Discussion

Adv Ren Replace Ther

Am J Kidney Dis

Kidney Int

Adv Ren Replace Ther

Adv Ren Replace Ther

Adv Ren Replace Ther

Nocturnal home haemodialysisAn update on a 5-year experience

Nephrol Dial Transplant

Short daily versus long nocturnal hemodialysis

ASAIO J

Fifteen years of clinical experience with daily hemodialysis

Nephrol Dial Transplant