title: The cost of starting and maintaining a large home hemodialysis program.
abstract: Home extended hours hemodialysis improves some measurable biological and quality-of-life parameters over conventional renal replacement therapies in patients with end-stage renal disease. Published small studies evaluating costs have shown savings in terms of ongoing operating costs with this modality. However, all estimates need to include the total costs, including infrastructure, patient training, and maintenance; patient attrition by death, transplantation, technique failure; and the necessity of in-center dialysis. We describe a comprehensive funding model for a large centrally administered but locally delivered home hemodialysis program in British Columbia, Canada that covered 122 patients, of which 113 were still in the program at study end. The majority of patients performed home nocturnal hemodialysis in this 2-year retrospective study. All training periods, both in-center and in-home dialysis, medications, hospitalizations, and deaths were captured using our provincial renal database and vital statistics. Comparative data from the provincial database and pricing models were used for costing purposes. The total comprehensive costs per patient-incorporating startup, home, and in-center dialysis; medications; home remodeling; and consumables-was $59,179 for years 2004-2005 and $48,648 for 2005-2006. The home dialysis patients required multiple in-center dialysis runs, significantly contributing to the overall costs. Our study describes a valid, comprehensive funding model delineating reliable cost estimates of starting and maintaining a large home-based hemodialysis program. Consideration of hidden costs is important for administrators and planners to take into account when designing budgets for home hemodialysis.
authors.affiliation: British Columbia Provincial Renal Agency, Vancouver, Canada. paulkomenda@yahoo.com
authors.forename: Paul
authors.initials: P
authors.lastname: Komenda
authors.forename: Michael
authors.initials: M
authors.lastname: Copland
authors.forename: Jay
authors.initials: J
authors.lastname: Makwana
authors.forename: Ogdjenka
authors.initials: O
authors.lastname: Djurdjev
authors.forename: Manish M
authors.initials: MM
authors.lastname: Sood
authors.forename: Adeera
authors.initials: A
authors.lastname: Levin
mesh_terms: D001955:British Columbia; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D017048:Health Care Costs; D006282:Health Personnel / Q000191:economics; D006436:Hemodialysis Units, Hospital / Q000191:economics; D006437:Hemodialysis, Home / Q000009:adverse effects / Q000191:economics* / Q000401:mortality; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007676:Kidney Failure, Chronic / Q000191:economics / Q000401:mortality / Q000628:therapy*; D018803:Models, Economic; D010353:Patient Education as Topic / Q000191:economics; D010561:Personnel Staffing and Scheduling / Q000191:economics; D016730:Program Development; D012189:Retrospective Studies; D013997:Time Factors