Cost savings of home nocturnal versus conventional in-center hemodialysis.
BACKGROUND
Home nocturnal hemodialysis (HNHD) can improve clinical and biochemical factors in people with renal failure, but its cost-effectiveness relative to conventional in-center hemodialysis (IHD) is uncertain. We hypothesized that HNHD would provide more dialysis treatments at a lower total cost than IHD.


METHODS
A prospective one-year descriptive costing study was performed at two centers in Toronto, Canada, involving patients enrolled from a HNHD program (N = 33), and a matched cohort from an IHD program (N = 23). All costs are expressed as mean weekly amount in Canadian year 2000 dollars. A projected mean annual cost (PMA) was calculated also.


RESULTS
The mean number of treatments per week was much higher with HNHD (5.7 vs. 3.0, P = 0.004). Cost categories found to be less expensive for HNHD were staffing (weekly $210 vs. $423, P < 0.001, PMA $10,932 vs. $22,056) and overhead and support (weekly $80 vs. $238, P < 0.001, PMA $4179 vs. $12,393). There was a trend toward lower costs for hospital admissions and procedures (weekly $23 vs. $134, P = 0.355, PMA $1173 vs. $6997) and for medications ($172 vs. $231, P = 0.082, PMA $8989 vs. $12,029). Costs found to be more expensive for HNHD were the cost of direct hemodialysis materials (weekly $318 vs. $126, P < 0.001, PMA $16,587 vs. $6575) and capital costs (weekly $118 vs. $17, P < 0.001, PMA $6139 vs. $871), with a trend toward higher cost for laboratory tests (weekly $33 vs. $26, P = 0.094, PMA $1744 vs. $1364). Physician costs were the same at $128 per week (PMA $6650). The weekly mean total cost for health care delivery was 20% less for HNHD ($1082 vs. $1322, P = 0.006), with projected mean annual costs more than $10,000 lower ($56,394 vs. $68,935).


CONCLUSIONS
HNHD provides about three times as many treatment hours at nearly a one-fifth lower cost, with savings evident even when only program and funding-specific costs are considered.
McFarlane
Philip A
PA
Home Dialysis, St. Michael's Hospital, Toronto, Ontario, Canada. phil.mcfarlane@utoronto.ca
Pierratos
Andreas
A
Redelmeier
Donald A
DA
D000328:Adult; D002201:Capital Expenditures; D017046:Cost Savings; D004921:Erythropoietin / Q000191:economics; D005260:Female; D017048:Health Care Costs; D006436:Hemodialysis Units, Hospital / Q000191:economics*; D006437:Hemodialysis, Home / Q000191:economics*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000191:economics* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009551:Night Care / Q000191:economics; D009864:Ontario; D010561:Personnel Staffing and Scheduling / Q000191:economics; D010820:Physicians / Q000191:economics; D011446:Prospective Studies; D012680:Sensitivity and Specificity
D004921:Erythropoietin