A costing model for use in evaluating the fiscal impact of home versus in-center dialysis within various healthcare systems

Purpose and Rationale An economic model was developed to calculate and contrast the costs to payers for providing three types of hemodialysis (HD) in Australia, Canada and the United States. The model was designed to provide decision-makers with a transparent tool for assessing the costs and cost drivers of hemodialysis modalities in the first year of treatment and beyond.

Methods Model inputs were derived from a literature review that yielded published cost input values as well as observational data from a clinical setting in Canada. The specific dialysis modalities used to develop the model comprised conventional in-center (ICHD), conventional home (CHHD), and nocturnal home hemodialysis (NHHD). Sensitivity analyses were conducted on all cost variables.

Results The model found that ICHD costs are stable over time and driven by staffing, renal medication, and infrastructure costs. CHHD and NHHD costs in year 1 are driven by renal medication costs, patient training costs, costs for machines, consumables, and home preparation. Subsequent year costs are driven by renal medication, consumables, and hospitalization costs. Costs for CHHD and NHHD were comparable to ICHD in year one and less than ICHD in subsequent years.

Conclusions These results reinforce findings from previous studies indicating that HHD modalities provide economic advantages over ICHD. As demand and associated costs for end-stage renal disease treatment increases in most countries, payers can use this model to better understand their hemodialysis costs. The model demonstrates the positive cost-impact from patients moving to home versus in-center hemodialysis modalities.