An operating cost comparison between conventional and home quotidian hemodialysis

Although several studies have shown that simulated annual direct health care costs are substantially lower for patients undergoing more frequent hemodialysis (HD), there is limited information about the economics of daily HD and nocturnal HD. The London Daily/Nocturnal Hemodialysis Study compared the economics of short daily HD (n = 10), long nocturnal HD (n = 12), and conventional thrice-weekly HD (n = 22) in patients over 18 months. A retrospective analysis of patients’ conventional HD costs during the 12 months before study entry was conducted to measure the change in cost after switching to quotidian HD. As the data show, annual costs (in Canadian dollars) for daily HD are substantially lower than for both nocturnal HD and conventional HD: approximately Can $67,300, Can $74,400, and Can $72,700 per patient, respectively. Moreover, marginal changes in operating cost per patient year were − Can $9,800, −Can $17,400, and +Can $3,100 for the daily HD, nocturnal HD, and conventional HD groups. Because of the increase in number of treatments, treatment supply costs per patient for the daily HD and nocturnal HD study groups were approximately twice those for conventional HD patients. However, average costs for consults, hospitalization days, emergency room visits, and laboratory tests for quotidian HD patients tended to decline after study entry. The major cost saving in home quotidian HD derived from the reduction in direct nursing time, excluding patient training. Total annualized cost per quality-adjusted life-year for the daily HD and nocturnal HD groups were Can $85,442 and Can $120,903, which represented a marginal change of − Can $15,090 and −Can $21,651, respectively, reflecting both improved quality of life and reduced costs for quotidian HD patients. Substantial clinical benefits of home quotidian HD, combined with the economic advantage shown by this study, clearly justify its expansion.