Assisted home dialysis found cost-effective for Canadian health care system
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Home dialysis with either partial or full assistance led to annual cost savings compared with dialysis administered in a hospital or center, an analysis evaluating the cost of maintenance care in Manitoba, Canada, showed.
“The purpose of our study is to provide a descriptive yearly cost analysis of assisted home-based dialysis modalities for patients with kidney failure at varying levels of assistance,” Ryan J. Bamforth, BA, of the department of community health sciences at the University of Manitoba, and colleagues wrote.
Cost-minimization model
“Following the methods outlined in Beaudry et al. (2018), this cost-minimization model is presented from the perspective of the Canadian single-payer health system and includes all direct and indirect dialysis related costs such as direct labor, supplies, equipment, in-center utilities, dialysis related drugs, overhead, training, and capital costs ... Furthermore, we build upon the original model by incorporating home assistance-specific human resource expenditures related to transportation, parking and cellular telephones to project the costs borne over time associated with full and partial nurse-assisted [continuous cycling peritoneal dialysis] CCPD and thrice-weekly conventional home [hemodialysis] HD.”
For full-assist home dialysis, a licensed practical nurse performed set-up and a health care aide performed takedown duties. For partial assist, only set-up was performed. Researchers also developed a “complete assist” scenario for home hemodialysis in which a health care aide remained with the patient throughout the 4-hour treatment.
Estimated costs of assisted home dialysis
Results showed the annual maintenance cost of delivering daily full-assist CCPD was $75,717 per patient with initial training costs of $301, while partial assist CCPD was $67,65 per patient with initial training costs of $4,385 (annual self-maintenance costs were $48,132 with self-training costs of $7,919).
For home hemodialysis delivered three times per week, full assistance led to annual maintenance costs of $47,862 per person with initial training costs of $301, while partial assistance costs were estimated to be $44,650 per patient with initial training costs of $14,813 (self-care costs totaled $36,618 per person with initial training estimated to be $25,486, while in-center annual maintenance costs were $67,416 with no training cost).
The complete care version was estimated to cost $64,659 per person per year with initial training costs of $301.
“Full and partial assist home HD are less costly than self-administered home HD in the first year inclusive of training costs and all assisted home HD scenarios considered in this analysis are less costly per year in comparison to in-center HD,” the researchers wrote. “The most cost-effective modality is suggested based on a patient’s projected time on a given form of dialysis.”
Study investigator Paul Komenda MD, FRCPC, MHA, FACP, told Healio Nephrology that the two main barriers to increasing uptake of home dialysis modalities are frailty and fear.
“If some element of assistance in the home can overcome these barriers, we should be providing assistance,” Komenda, an epidemiologist and professor of medicine at the University of Manitoba and research director of the Chronic Disease Innovation Centre in Winnipeg, said. “[While] full home support during the entire procedure of dialysis is unlikely [to be] cost effective, this model presents a rational, well-supported business case for the number of hours of support for patients who want home dialysis but are too fearful or frail to undertake it.”
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