title: The quality of life and cost utility of home nocturnal and conventional in-center hemodialysis.
abstract: BACKGROUND
  Home nocturnal hemodialysis is an intensive form of hemodialysis, where patients perform their treatments at home for about 7 hours approximately 6 nights a week. Compared with in-center conventional hemodialysis, home nocturnal hemodialysis has been shown to improve physiologic parameters and reduce health care costs; however, the effects on quality of life and cost utility are less clear. We hypothesized that individuals performing home nocturnal hemodialysis would have a higher quality of life and superior cost utility than in-center hemodialysis patients.
  
  
  METHODS
  Home nocturnal hemodialysis patients and a demographically similar group of in-center hemodialysis patients from a hospital without a home hemodialysis program underwent computer-assisted interviews to assess their utility score for current health by the standard gamble method.
  
  
  RESULTS
  Nineteen in-center hemodialysis and 24 home nocturnal hemodialysis patients were interviewed. Mean annual costs for home nocturnal hemodialysis were about 10,000 dollars lower for home nocturnal hemodialysis (55,139 dollars +/- 7651 dollars for home nocturnal hemodialysis vs. 66,367 dollars +/- 17,502 dollars for in-center hemodialysis, P = 0.03). Home nocturnal hemodialysis was associated with a higher utility score than in-center hemodialysis (0.77 +/- 0.23 vs. 0.53 +/- 0.35, P = 0.03). The cost utility for home nocturnal hemodialysis was 71,443 dollars/quality-adjusted life-year (QALY), while for in-center hemodialysis it was 125,845 dollars/QALY. Home nocturnal hemodialysis was the dominant strategy, with an incremental cost-effectiveness ratio (ICER) of -45,932 dollars. The 95% CI for the ICER, and 2500 bootstrap iterations of the ICER all fell below the cost-effectiveness ceiling of 50,000 dollars. The net monetary benefit of home nocturnal hemodialysis ranged from 11,227 dollars to 35,669 dollars.
  
  
  CONCLUSIONS
  Home nocturnal hemodialysis is associated with a higher quality of life and a superior cost utility when compared to in-center hemodialysis.
authors.affiliation: Department of Medicine, Home Dialysis Clinic, Inner City Health Research Unit, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada. phil.mcfarlane@utoronto.ca
authors.forename: Philip A
authors.initials: PA
authors.lastname: McFarlane
authors.forename: Ahmed M
authors.initials: AM
authors.lastname: Bayoumi
authors.forename: Andreas
authors.initials: A
authors.lastname: Pierratos
authors.forename: Donald A
authors.initials: DA
authors.lastname: Redelmeier
mesh_terms: D000328:Adult; D002940:Circadian Rhythm; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs; D006436:Hemodialysis Units, Hospital; D006437:Hemodialysis, Home / Q000191:economics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D006435:Renal Dialysis / Q000191:economics*