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BMC Nephrology

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Open Access 01-12-2014 | Research article

The financial impact of increasing home-based high dose haemodialysis and peritoneal dialysis

Authors: Frank Xiaoqing Liu, Catrin Treharne, Bruce Culleton, Lydia Crowe, Murat Arici

Published in: BMC Nephrology | Issue 1/2014

Abstract

Background

Evidence suggests that high dose haemodialysis (HD) may be associated with better health outcomes and even cost savings (if conducted at home) versus conventional in-centre HD (ICHD). Home-based regimens such as peritoneal dialysis (PD) are also associated with significant cost reductions and are more convenient for patients. However, the financial impact of increasing the use of high dose HD at home with an increased tariff is uncertain. A budget impact analysis was performed to investigate the financial impact of increasing the proportion of patients receiving home-based dialysis modalities from the perspective of the England National Health Service (NHS) payer.

Methods

A Markov model was constructed to investigate the 5 year budget impact of increasing the proportion of dialysis patients receiving home-based dialysis, including both high dose HD at home and PD, under the current reimbursement tariff and a hypothetically increased tariff for home HD (£575/week). Five scenarios were compared with the current England dialysis modality distribution (prevalent patients, 14.1% PD, 82.0% ICHD, 3.9% conventional home HD; incident patients, 22.9% PD, 77.1% ICHD) with all increases coming from the ICHD population.

Results

Under the current tariff of £456/week, increasing the proportion of dialysis patients receiving high dose HD at home resulted in a saving of £19.6 million. Conducting high dose HD at home under a hypothetical tariff of £575/week was associated with a budget increase (£19.9 million). The costs of high dose HD at home were totally offset by increasing the usage of PD to 20–25%, generating savings of £40.0 million – £94.5 million over 5 years under the increased tariff. Conversely, having all patients treated in-centre resulted in a £172.6 million increase in dialysis costs over 5 years.

Conclusion

This analysis shows that performing high dose HD at home could allow the UK healthcare system to capture the clinical and humanistic benefits associated with this therapy while limiting the impact on the dialysis budget. Increasing the usage of PD to 20-25%, the levels observed in 2005-2008, will totally offset the additional costs and generate further savings.

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The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2369/15/161/prepub

Title: The financial impact of increasing home-based high dose haemodialysis and peritoneal dialysis
Authors: Frank Xiaoqing Liu
Catrin Treharne
Bruce Culleton
Lydia Crowe
Murat Arici
Publication date: 01-12-2014
Publisher: BioMed Central
Published in: BMC Nephrology / Issue 1/2014
Electronic ISSN: 1471-2369
DOI: https://doi.org/10.1186/1471-2369-15-161

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