A Cochrane review [Abstract] 3 included 1 single cross-over RCT (enrolling 9 participants) that compared home haemodialysis with in-centre haemodialysisfor 8 weeks in prevalent home haemodialysis patients. 39 non-randomised studies of interventions were also included. There were no clear differences in health outcomes such as death, hospital admission, or kidney transplantation,
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.
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