title: The financial impact of increasing home-based high dose haemodialysis and peritoneal dialysis.
abstract: 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 (£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 £456/week, increasing the proportion of dialysis patients receiving high dose HD at home resulted in a saving of £19.6 million. Conducting high dose HD at home under a hypothetical tariff of £575/week was associated with a budget increase (£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 million - £94.5 million over 5 years under the increased tariff. Conversely, having all patients treated in-centre resulted in a £172.6 million increase in dialysis costs over 5 years.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Baxter Healthcare Corporation, One Baxter Parkway, Deerfield, IL, USA. Xiaoqing_liu@baxter.com.
authors.forename: Frank Xiaoqing
authors.initials: FX
authors.lastname: Liu
authors.forename: Catrin
authors.initials: C
authors.lastname: Treharne
authors.forename: Bruce
authors.initials: B
authors.lastname: Culleton
authors.forename: Lydia
authors.initials: L
authors.lastname: Crowe
authors.forename: Murat
authors.initials: M
authors.lastname: Arici
mesh_terms: D002017:Budgets / Q000706:statistics & numerical data; D017046:Cost Savings / Q000706:statistics & numerical data; D003365:Costs and Cost Analysis / Q000706:statistics & numerical data; D004739:England / Q000453:epidemiology; D018588:Fee-for-Service Plans / Q000191:economics; D006437:Hemodialysis, Home / Q000191:economics* / Q000706:statistics & numerical data; D006699:Home Care Services / Q000191:economics / Q000706:statistics & numerical data; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007676:Kidney Failure, Chronic / Q000191:economics* / Q000401:mortality / Q000628:therapy; D008390:Markov Chains; D009313:National Health Programs / Q000191:economics; D010530:Peritoneal Dialysis / Q000191:economics* / Q000379:methods / Q000706:statistics & numerical data; D014187:Transportation of Patients / Q000191:economics