The true cost of dialysis modalities: A detailed analysis from a UK renal centre

Purpose Dialysis accounts for more than £1 billion of annual NHS expenditure, yet contemporary modality-specific costing studies using real-world operational data remain limited. Accurate cost estimates are essential for service planning, reimbursement, and workforce allocation. We hypothesised that home-based dialysis modalities, particularly home haemodialysis (HHD) and continuous ambulatory peritoneal dialysis (CAPD), would be less costly and associated with a more favourable cost–benchmark margin than in-centre haemodialysis (ICHD) when workforce, consumables, infrastructure, and overheads were fully allocated. Materials and methods A comprehensive micro-costing analysis was undertaken at University Hospitals of Derby and Burton NHS Foundation Trust during 2023–24. Costs were derived from Trust financial ledgers, consultant job plans, workforce activity mapping, consumable expenditure, maintenance, administration, and overhead allocations. Cost-centre and account-code methodologies were used to attribute expenditure to specific dialysis modalities. Costs were compared with NHS Best Practice Tariff reimbursement after adjustment for Market Forces Factor. HHD was evaluated according to treatment frequency, and peritoneal dialysis (PD) costs were analysed by modality. Results A total of 45,157 in-centre haemodialysis (ICHD) sessions, 5,326 satellite haemodialysis (SHD) sessions, and 31,737 peritoneal dialysis (PD) treatment days were delivered. For cross-modality comparison, annual per-patient treatment costs were £25,598 for ICHD, £26,678 for SHD, £16,573 for CAPD, £36,859 for CCPD, £41,085 for AAPD, and £18,320, £24,427 and £30,534 for HHD delivered three, four and five times weekly, respectively. CAPD and three-times-weekly HHD had the lowest annual provider costs. Comparisons with NHS Best Practice Tariff (BPT) values were treated as standardised financial benchmarks rather than measures of clinical cost-effectiveness or necessarily as incremental cash reimbursement under the NHS Payment Scheme. Five-times-weekly HHD had a small negative benchmark margin, whereas three- and four-times-weekly HHD had positive margins. Conclusions HHD and CAPD were among the lower-cost modalities or were associated with favourable benchmark margins within current English reimbursement structures. This micro-costing methodology provides a reproducible framework for evaluating dialysis costs and informing service planning for home-based dialysis pathways.