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The Cost-Effectiveness of Initiating Patients on Home Dialysis Compared with In-Centre Haemodialysis

Author

Listed:
  • Harry Hill

    (University of Sheffield)

  • James Fotheringham

    (University of Sheffield
    Northern General Hospital)

  • Jessica Potts

    (Keele University)

  • Ivonne Solis-Trapala

    (Keele University)

  • Mark Lambie

    (Keele University)

  • Sarah Damery

    (University of Birmingham)

  • Kerry Allen

    (University of Birmingham)

  • Allan Wailoo

    (University of Sheffield)

  • Iestyn Williams

    (University of Birmingham)

  • Simon Davies

    (Keele University)

Abstract

Objectives Kidney failure can be treated at home with peritoneal dialysis or home haemodialysis. The combination of reduced staffing, transport and overhead costs and improved quality of life through treatment at home could make initiating dialysis at home highly cost-effective. The primary objective is to estimate the cost-effectiveness of initiating patients on home dialysis therapy (HDT) compared with in-centre haemodialysis (ICHD). The secondary objective is to determine the upper limit of net benefit from removing potential service barriers within dialysis centres that hinder the adoption of HDT. Method A multistate model using UK Renal Registry data combined with national survey data was developed to estimate patient and dialysis centre influences on dialysis treatment modality changes and the duration in each modality. These are used as inputs to a microsimulation estimating the lifetime quality-adjusted life years (QALYs) and UK National Health Service (NHS) costs incurred for patients, the cost-effectiveness of HDT compared with ICHD and the differences in costs and health outcomes associated with removing specific barriers to HDT uptake. Results Commencing HDT compared with ICHD resulted in 0.30 additional QALYs and saved Great British (GB) £15,272. HDT has an 82% probability of being cost-effective. Implementing quality-improvement initiatives and alleviating stresses on staff capacity are identified as influential in the multistate model. Addressing these led to QALY gains of 0.22 and 0.08 and cost increases of GB £10,059 and GB £5127 from an increase of life years lived of 0.54 and 0.22, respectively. Conclusions Initiating patients on HDT is cost-effective compared with ICHD. Alleviating stresses on staff capacity and implementing quality improvement initiatives in dialysis centres leads to health improvements, although these changes are not cost-effective owing to the associated increase in healthcare costs.

Suggested Citation

  • Harry Hill & James Fotheringham & Jessica Potts & Ivonne Solis-Trapala & Mark Lambie & Sarah Damery & Kerry Allen & Allan Wailoo & Iestyn Williams & Simon Davies, 2025. "The Cost-Effectiveness of Initiating Patients on Home Dialysis Compared with In-Centre Haemodialysis," Applied Health Economics and Health Policy, Springer, vol. 23(5), pages 919-929, September.
    • Handle: RePEc:spr:aphecp:v:23:y:2025:i:5:d:10.1007_s40258-025-00976-7
    DOI: 10.1007/s40258-025-00976-7
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    1. Eline M. Krijkamp & Fernando Alarid-Escudero & Eva A. Enns & Hawre J. Jalal & M. G. Myriam Hunink & Petros Pechlivanoglou, 2018. "Microsimulation Modeling for Health Decision Sciences Using R: A Tutorial," Medical Decision Making, , vol. 38(3), pages 400-422, April.
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