Hill, H. orcid.org/0000-0002-0908-5595, Fotheringham, J., Potts, J. et al. (7 more authors) (2025) The cost-effectiveness of initiating patients on home dialysis compared with in-centre haemodialysis. Applied Health Economics and Health Policy. ISSN 1175-5652
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.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © 2025 The Authors. This article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc/4.0/. |
Keywords: | Chronic kidney disease; Continuous renal replacement therapy; End-stage renal disease; Haemodialysis; Health Economics; Renal replacement therapy |
Dates: |
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Institution: | The University of Sheffield |
Academic Units: | The University of Sheffield > Faculty of Medicine, Dentistry and Health (Sheffield) > School of Medicine and Population Health |
Funding Information: | Funder Grant number DEPARTMENT OF HEALTH AND SOCIAL CARE NIHR 128364 |
Depositing User: | Symplectic Sheffield |
Date Deposited: | 27 May 2025 08:38 |
Last Modified: | 27 May 2025 08:38 |
Published Version: | https://doi.org/10.1007/s40258-025-00976-7 |
Status: | Published online |
Publisher: | Springer Science and Business Media LLC |
Refereed: | Yes |
Identification Number: | 10.1007/s40258-025-00976-7 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:227099 |