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Evidence summaries

Home Compared with Hospital Haemodialysis

Haemodialysis at home may be a cost-effective alternative for selected patients with end-stage renal failure. Level of evidence: "C"

A Cochrane review [Abstract] 3 included 1 single cross-over RCT (enrolling 9 participants) that compared home haemodialysis (long hours: 6 to 8 hours, 3 times/week) with in-centre haemodialysis (short hours: 3.5 to 4.5 hours, 3 times/weeks) for 8 weeks in prevalent home haemodialysis patients. Home haemodialysis reduced 24 hour ambulatory blood pressure and improved uraemic symptoms, but increased treatment-related burden of disease and interference in social activities.

A cost analysis 4 was based on 402 patients on maintenance dialysis in Hongkong (peritoneal dialysis PD 189; hospital-based haemodailysisi HD 170; and nocturnal home HD 43). Hospital-based HD had the highest total annual direct medical costs in the initial year (mean ± SD) (hospital-based HD $400 057 ± 62 822; PD $118 467 ± 15 559; nocturnal home HD $223 358 ± 18 055; P < 0.001) and second year (hospital-based HD $360 924 ± 63 014; PD $80 796 ± 15 820; nocturnal home HD $87 028 ± 9059; P < 0.001). From the societal perspective, hospital-based HD had the highest total annual costs in the initial year and second year.

A technology assessment report 1 on haemodialysis at home was abstracted in the Health Technology Assessment Database 2. Four systematic reviews, one randomised crossover trial and 22 comparative observational studies were found for review. The overall quality of the primary studies was low with highly selected patient groups, and the majority of the studies were pre-1990. Most studies found patient survival to be at least equal or better for home haemodialysis compared with hospital dialysis. Some patients might have undertaken more frequent dialysis at home than is the norm in hospitals. A cost model prepared for this review indicated that with threetimes-weekly dialysis, the annual cost of home haemodialysis was always less than haemodialysis in a satellite unit or hospital. However, lifetime treatment costs for an identical group of patients will be higher for home haemodialysis if the treatment is beneficial and leads to longer survival.

    References

    • National Institute for Clinical Excellence. Guidance on home compared with hospital haemodialysis for patients with end-stage renal failure. London: National Institute for Clinical Excellence (NICE). 2002. 24. National Institute for Clinical Excellence (NICE). http://www.nice.org.uk/nicemedia/pdf/HvH_full_guidance.pdf
    • Health Technology Assessment Database: HTA-20030006. The Cochrane Library, Issue 1, 2004. Chichester, UK: John Wiley & Sons, Ltd.
    • Palmer SC, Palmer AR, Craig JC et al. Home versus in-centre haemodialysis for end-stage kidney disease. Cochrane Database Syst Rev 2014;(11):CD009535. [PubMed]
    • Wong CKH, Chen J, Fung SKS et al. Direct and indirect costs of end-stage renal disease patients in the first and second years after initiation of nocturnal home haemodialysis, hospital haemodialysis and peritoneal dialysis. Nephrol Dial Transplant 2019;34(9):1565-1576. [PubMed]

Primary/Secondary Keywords