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

Q: What are the key findings of this study?

Hospital-based hemodialysis incurred the highest initial-year direct medical costs ($400,057) compared to nocturnal home HD ($223,358) and peritoneal dialysis ($118,467; P<0.001).

Q: What is the clinical evidence from this study?

Study design: Observational. Population: end-stage renal disease (ESRD) (n=402). Intervention: Hospital-based haemodialysis vs. Peritoneal dialysis and nocturnal home haemodialysis. Primary outcome: Total annual direct medical costs in the initial year (p=<0.001).

Q: What does this research mean for the field?

Hospital-based hemodialysis incurs significantly higher direct medical and societal costs during the first two years of treatment compared to peritoneal dialysis and nocturnal home hemodialysis. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To evaluate and compare the annual direct and indirect costs associated with peritoneal dialysis, hospital-based haemodialysis, and nocturnal home haemodialysis during the first two years of therapy.

Carlos King Ho Wong; Julie Chen; Samuel Fung; Maggie Ming Yee Mok; Yuk Lun Cheng; Irene Kong; Wai Kei Lo; Sing Leung Lui; Tak Mao Chan; Cindy Lo Kuen Lam

doi:10.1093/ndt/gfy395

November 30, 2018Nephrology Dialysis Transplantation

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

View Full Paper

Ask AI

Bookmark

Share

Key result

Hospital-based HD incurs ~$400,000 in initial-year medical costs, far exceeding home HD and PD.

P<0.001
n=402

Why the study?

The economic burden and annual healthcare and societal costs of ESRD patients undergoing PD, hospital-based HD, and nocturnal home HD in the first two years were not well quantified in Hong Kong.

What are the comparative direct and indirect costs of peritoneal dialysis, hospital-based haemodialysis, and nocturnal home haemodialysis in ESRD patients?

Key Points

To evaluate and compare the annual direct and indirect costs associated with peritoneal dialysis, hospital-based haemodialysis, and nocturnal home haemodialysis during the first two years of therapy.
Conducted a cost analysis including 402 patients with end-stage renal disease on maintenance dialysis (peritoneal dialysis: n=189; hospital-based haemodialysis: n=170; nocturnal home haemodialysis: n=43) in Hong Kong.
Calculated healthcare provider direct medical costs and societal costs (including out-of-pocket expenses and patient/caregiver time for transport and dialysis) in 2017 Hong Kong dollars across years one and two.
From the healthcare provider perspective, hospital-based haemodialysis incurred the highest annual direct costs in year one ($400,057 ± 62,822 vs. $118,467 ± 15,559 for PD and $223,358 ± 18,055 for nocturnal home HD; P < 0.001) and year two ($360,924 ± 63,014 vs. $80,796 ± 15,820 for PD and $87,028 ± 9,059 for nocturnal home HD; P < 0.001).
From the societal perspective, hospital-based haemodialysis remained the most expensive modality across both years, whereas nocturnal home haemodialysis became the least costly option by year two ($105,708 ± 23,853 vs. $151,520 ± 60,353 for PD and $413,017 ± 73,501 for hospital HD; P < 0.001).

Study Design

Type

Observational (n=402)

Structured PICO

What are the comparative direct and indirect costs of peritoneal dialysis, hospital-based haemodialysis, and nocturnal home haemodialysis in ESRD patients?

P

Population

402 end-stage renal disease patients on maintenance dialysis in Hong Kong, evaluated for healthcare and societal costs in the first and second years of treatment.

E

Exposure

Peritoneal dialysis (PD), hospital-based haemodialysis (HD), and nocturnal home HD

C

Comparator

Compared against each other

O

Outcome

Annual direct and indirect costs in the first and second years of initiating dialysis from healthcare provider and societal perspectives

Main Result

p-value: p=<0.001

Peritoneal dialysis is generally cost-saving relative to hospital-based and nocturnal home haemodialysis in the first two years, though nocturnal home HD has the lowest societal cost in the second year.

Implication

PD costs least in most early-year scenarios; leaves open generalizability of nocturnal home HD savings beyond this single-center analysis.

Abstract

PURPOSE: To estimate the direct and indirect costs of end-stage renal disease (ESRD) patients in the first and second years of initiating peritoneal dialysis (PD), hospital-based haemodialysis (HD) and nocturnal home HD. METHODS: A cost analysis was performed to estimate the annual costs of PD, hospital-based HD and nocturnal home HD for ESRD patients from both the health service provider's and societal perspectives. Empirical data on healthcare resource use, patients' out-of-pocket costs, time spent on transportation and dialysis by ESRD patients and time spent by caregivers were analysed. All costs were expressed in Hong Kong year 2017 dollars. RESULTS: Analysis was based on 402 ESRD patients on maintenance dialysis (PD: 189; hospital-based HD: 170; and nocturnal home HD: 43). From the perspective of the healthcare provider, 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 (hospital-based HD = $452 151 ± 73 327; PD = $189 191 ± 61 735; nocturnal home HD = $242 038 ± 28 281; P < 0.001) and second year (hospital-based HD = $413 017 ± 73 501; PD = $151 520 ± 60 353; nocturnal home HD = $105 708 ± 23 853; P < 0.001). CONCLUSIONS: This study quantified the economic burden of ESRD patients, and assessed the annual healthcare and societal costs in the initial and second years of PD, hospital-based HD and nocturnal home HD in Hong Kong. From both perspectives, PD is cost-saving relative to hospital-based HD and nocturnal home HD, except that nocturnal home HD has the lowest cost in the second year of treatment from the societal perspective. Results from this cost analysis facilitate economic evaluation in Hong Kong for health services and management targeted at ESRD patients.

Discussion

No takes yet. Share an insight, caveat, or question.

Cite This Study

Wong et al. (2018) conducted an observational in end-stage renal disease (ESRD) (n=402). Hospital-based haemodialysis vs. Peritoneal dialysis and nocturnal home haemodialysis was evaluated on Total annual direct medical costs in the initial year (p=<0.001). Hospital-based hemodialysis incurred the highest initial-year direct medical costs ($400,057) compared to nocturnal home HD ($223,358) and peritoneal dialysis ($118,467; P<0.001).

synapsesocial.com/papers/6aae497084472a07f6742018 https://doi.org/10.1093/ndt/gfy395

View Full Paper

Ask AI

Bookmark

Share

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

Key Points

Study Design

Structured PICO

Main Result

Implication

Abstract

Discussion

Cite This Study

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

Key Points

Study Design

Structured PICO

Main Result

Implication

Abstract

Discussion

Cite This Study

Keep reading

Keep reading