Feasibility of Home Hemodialysis for Colombia, Cost-Effectiveness Perspective

OBJECTIVES: To assess the incremental cost-utility ratio of home hemodialysis (HHD) compared with in-center hemodialysis (HD) among Colombian patients with end-stage renal disease with contraindications or failure of peritoneal dialysis. METHODS: A Markov model was constructed from the healthcare system and societal perspectives over a 5-year horizon. The primary outcomes were quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios. Costs included direct medical costs from microcosting and indirect costs based on patient surveys. Data were collected in Colombian pesos (COP) and converted to USD (2022 average exchange rate: USD 1 = COP 4255.44). Sensitivity analyses were conducted using Monte Carlo simulations in R Studio. RESULTS: From the payer perspective, HHD generated incremental costs of USD 25 928 and 0.31 additional QALYs compared with HD, yielding an incremental cost-effectiveness ratios of USD 82 674 per QALY gained, exceeding the cost-effectiveness threshold for Colombia (USD 6630 per QALY). From the societal perspective, incorporating indirect costs significantly improved HHD's cost-effectiveness profile, demonstrating potential economic viability. CONCLUSIONS: Although home hemodialysis is not cost-effective from a third-party payer perspective in Colombia, it becomes a viable alternative when considering indirect costs and out-of-pocket expenses. This study highlights the need for health policy decisions in Latin America to be based on comprehensive assessments that go beyond direct medical costs.