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

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 ( pound 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 pound 456/week, increasing the proportion of dialysis patients receiving high dose HD at home resulted in a saving of pound 19.6 million. Conducting high dose HD at home under a hypothetical tariff of pound 575/week was associated with a budget increase ( pound 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 pound million - pound 94.5 million over 5 years under the increased tariff. Conversely, having all patients treated in-centre resulted in a 172.6 pound 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.