The Cost-Effectiveness of Initiating Patients on Home Dialysis Compared with In-Centre Haemodialysis.

IF 3.1 4区 医学 Q1 ECONOMICS
Harry Hill, James Fotheringham, Jessica Potts, Ivonne Solis-Trapala, Mark Lambie, Sarah Damery, Kerry Allen, Allan Wailoo, Iestyn Williams, Simon Davies
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Abstract

Objectives: Kidney failure can be treated at home with peritoneal dialysis or home haemodialysis. The combination of reduced staffing, transport and overhead costs and improved quality of life through treatment at home could make initiating dialysis at home highly cost-effective. The primary objective is to estimate the cost-effectiveness of initiating patients on home dialysis therapy (HDT) compared with in-centre haemodialysis (ICHD). The secondary objective is to determine the upper limit of net benefit from removing potential service barriers within dialysis centres that hinder the adoption of HDT.

Method: A multistate model using UK Renal Registry data combined with national survey data was developed to estimate patient and dialysis centre influences on dialysis treatment modality changes and the duration in each modality. These are used as inputs to a microsimulation estimating the lifetime quality-adjusted life years (QALYs) and UK National Health Service (NHS) costs incurred for patients, the cost-effectiveness of HDT compared with ICHD and the differences in costs and health outcomes associated with removing specific barriers to HDT uptake.

Results: Commencing HDT compared with ICHD resulted in 0.30 additional QALYs and saved Great British (GB) £15,272. HDT has an 82% probability of being cost-effective. Implementing quality-improvement initiatives and alleviating stresses on staff capacity are identified as influential in the multistate model. Addressing these led to QALY gains of 0.22 and 0.08 and cost increases of GB £10,059 and GB £5127 from an increase of life years lived of 0.54 and 0.22, respectively.

Conclusions: Initiating patients on HDT is cost-effective compared with ICHD. Alleviating stresses on staff capacity and implementing quality improvement initiatives in dialysis centres leads to health improvements, although these changes are not cost-effective owing to the associated increase in healthcare costs.

启动患者家庭透析与中心血液透析的成本-效果比较。
目的:肾衰竭可在家中通过腹膜透析或家庭血液透析治疗。减少人员配备、运输和间接费用以及通过在家治疗改善生活质量的结合,可以使在家开始透析具有很高的成本效益。主要目的是评估与中心血液透析(ICHD)相比,开始进行家庭透析治疗(HDT)的患者的成本效益。第二个目标是确定消除透析中心内阻碍采用HDT的潜在服务障碍所带来的净效益上限。方法:采用英国肾登记数据结合全国调查数据,建立了一个多州模型,以估计患者和透析中心对透析治疗模式变化和每种模式持续时间的影响。这些数据被用作微观模拟的输入,用于估计患者终生质量调整生命年(QALYs)和英国国民健康服务(NHS)成本,HDT与ICHD相比的成本效益,以及与消除HDT摄取特定障碍相关的成本和健康结果的差异。结果:与ICHD相比,开始HDT增加了0.30个QALYs,节省了英国(GB) 15,272英镑。HDT的成本效益概率为82%。在多状态模式中,实施质量改进举措和减轻工作人员能力压力被认为是有影响的。解决了这些问题后,质量质量提高了0.22和0.08,寿命年分别增加了0.54和0.22,成本分别增加了10059英镑和5127英镑。结论:与ICHD相比,启动HDT患者具有成本效益。减轻对透析中心工作人员能力的压力和实施改善质量的举措可改善健康状况,尽管由于相关的保健费用增加,这些变化不符合成本效益。
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来源期刊
Applied Health Economics and Health Policy
Applied Health Economics and Health Policy Economics, Econometrics and Finance-Economics and Econometrics
CiteScore
6.10
自引率
2.80%
发文量
64
期刊介绍: Applied Health Economics and Health Policy provides timely publication of cutting-edge research and expert opinion from this increasingly important field, making it a vital resource for payers, providers and researchers alike. The journal includes high quality economic research and reviews of all aspects of healthcare from various perspectives and countries, designed to communicate the latest applied information in health economics and health policy. While emphasis is placed on information with practical applications, a strong basis of underlying scientific rigor is maintained.
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