Nocturnal haemodialysis: an Australian cost comparison with conventional satellite haemodialysis

Abstract

Dialysis is an expensive therapy, particularly considering its recurrent, protracted nature while patient numbers are also increasing. To afford dialysis for those in need, smarter, more efficient use of limited funds is mandatory. Newer techniques and improved equipment now permit safe, highly effective haemodialysis (HD) at home, alone and while asleep. Indeed, the increase in treatment hours and frequency achieved through nocturnal HD both increase HD efficiency and reduce cardiovascular stress when comparing nocturnal HD (6 nights/week for 8 h/treatment) to conventional daytime HD (4 h/treatment, three times/week). This study compares the expenditure of two distinct HD programmes in the same renal service during the Australian financial year 2003/2004. A conventional satellite HD unit (SHDU) and a nocturnal home HD programme (NHHD(6)) are compared, with both programmes 'notionalised' to 30 patients. The state-derived funding models under which these programmes operate are explained. All wage costs, recurrent expenditure, fixed costs and the estimated costs of building and infrastructure are included. The total NHHD(6) programme expenditure was 33,392 Australian dollars/patient per year (103.82 Australian dollars/treatment) and was 3,892 Australian dollars/patient per year less (a 10.75% saving) when compared with the SHDU expenditure of 36,284 Australian dollars/patient per year (232.58 Australian dollars/treatment). This represented an annual 116,750 Australian dollars programme saving for a 30 patient cohort. Potential additional NHHD(6) savings in erythropoietin, hospitalization and social security dependence were also identified. Home-based therapies are clinically sound, effective and fiscally prudent and efficient. Funding models should reward home-based HD. Health services should encourage home training and support systems, sustaining patients at home wherever possible.