Lin
Joined: 28 Oct 2002
Posts: 337
Posted: Mon Aug 18, 2003 3:45 am Post subject: Cost effectiveness of home hemo/new study
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I just read this, and wanted to share; Canadians are whooping our behinds but good! lol <
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>Kidney International<
>Volume 64 Issue 3 Page 1004 - September 2003<
>doi:10.1046/j.1523-1755.2003.00157.x <
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>The quality of life and cost utility of home nocturnal and conventional in-center hemodialysis <
>Philip A. Mcfarlane, Ahmed M. Bayoumi, Andreas Pierratos, and Donald A. Redelmeier <
>The quality of life and cost utility of home nocturnal and conventional in-center hemodialysis.<
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>Background. Home nocturnal hemodialysis is an intensive form of hemodialysis, where patients perform their treatments at home for about 7 hours approximately 6 nights a week. Compared with in-center conventional hemodialysis, home nocturnal hemodialysis has been shown to improve physiologic parameters and reduce health care costs; however, the effects on quality of life and cost utility are less clear. We hypothesized that individuals performing home nocturnal hemodialysis would have a higher quality of life and superior cost utility than in-center hemodialysis patients.<
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>Methods. Home nocturnal hemodialysis patients and a demographically similar group of in-center hemodialysis patients from a hospital without a home hemodialysis program underwent computer-assisted interviews to assess their utility score for current health by the standard gamble method.<
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>Results. Nineteen in-center hemodialysis and 24 home nocturnal hemodialysis patients were interviewed. Mean annual costs for home nocturnal hemodialysis were about $10,000 lower for home nocturnal hemodialysis ($55,139 ?$7651 for home nocturnal hemodialysis vs. $66,367 ?$17,502 for in-center hemodialysis, P = 0.03). Home nocturnal hemodialysis was associated with a higher utility score than in-center hemodialysis (0.77 ? 0.23 vs. 0.53 ? 0.35, P = 0.03). The cost utility for home nocturnal hemodialysis was $71,443/quality-adjusted life-year (QALY), while for in-center hemodialysis it was $125,845/QALY. Home nocturnal hemodialysis was the dominant strategy, with an incremental cost-effectiveness ratio (ICER) of $45,932. The 95% CI for the ICER, and 2500 bootstrap iterations of the ICER all fell below the cost-effectiveness ceiling of $50,000. The net monetary benefit of home nocturnal hemodialysis ranged from $11,227 to $35,669.<
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>Conclusion. Home nocturnal hemodialysis is associated with a higher quality of life and a superior cost utility when compared to in-center hemodialysis.<
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>Authors: <
>Philip A. Mcfarlane <
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>Donald A. Redelmeier <
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>Received for publication January 28, 2003 and in revised form March 27, 2003 Accepted for publication April 23, 2003<
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>Affiliations<
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>Department of Medicine, Home Dialysis Clinic, Inner City Health Research Unit, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Home Dialysis, Humber River Regional Hospital, Toronto, Ontario, Canada; and Clinical Epidemiology, Sunny
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>Correspondence<
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>Reprint requests to Philip A. McFarlane, Director of Home Dialysis, St. Michael's Hospital, 61 Queen St. E., 9th Floor, Toronto, Ontario, Canada M5C 2T2. E-mail: phil.mcfarlane@utoronto.ca <
>To cite this article<
>Mcfarlane, Philip A., Bayoumi, Ahmed M., Pierratos, Andreas & Redelmeier, Donald A. (2003)<
>The quality of life and cost utility of home nocturnal and conventional in-center hemodialysis.<
>Kidney International 64 (3), 1004-1011.<
>doi: 10.1046/<
>j.1523-1755.2003.00157.x <
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Marty
Joined: 28 Oct 2002
Posts: 160
Posted: Wed Aug 20, 2003 2:40 am Post subject: Proof in the Pudding
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I have no dispute with this. I have seen the results in slow nocturnal patients. I can believe the cost are less we are going on 30 patients and only require 1 nurse and 1 tech. Not to mention that is 30 patients paying their own overhead, electric, water, heat etc. I don't know the medical history of the other patients but I do know my father hasn't had a hospital stay since starting slow nocturnal and before that he was in a couple of times a year. Infection, BP you name it.
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ridgerunner
Joined: 11 Jan 2003
Posts: 101
Posted: Wed Aug 20, 2003 12:37 pm Post subject: home dialysis
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all the facts are true. but the control nuts will lose control and i would the two half jiffy lube with 100 plus reuse, using untrained personell would make more money the next quarter but what price.
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Lin
Joined: 28 Oct 2002
Posts: 337
Posted: Thu Aug 21, 2003 12:15 am Post subject: Home hemo
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I think they have
ochures and such saying they offer home hemo, but don't have any pts. in a program! The unit I go to uses a sister unit a distance away for training but when I asked how many were in the program got hedged! Hmmm I wonder! <
>People hear of the benefits and want to do it, but it's just too stressfull having to fight for it to be available. Why (considering the cost savings) isn't the government insisting units offer it? Lin.
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jfwag
Joined: 11 Jan 2003
Posts: 140
Posted: Mon Aug 25, 2003 3:12 am Post subject: This is...
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just the type of study I love. To me it just seems like common sense but I understand that they actually have to do this study. Hope it gets sent to our own Congress. Maybe we should all copy and paste this and send it to our indvidual Congresspeople and Senators.
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Marty
Joined: 28 Oct 2002
Posts: 160
Posted: Mon Aug 25, 2003 8:50 am Post subject: Goverment Insisting
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I don't think the government is insisting because they don't have the "b----" to stand up to the big corporations. We know home dialysis would save them money; what we don't know is how much the companies are contributing to different government representatives. I would guess they have a whole lot of lobbiest hanging around Washington. I doubt
if we will ever know the truth or get to the bottom of it. Decisions of starting home programs are started at upper management and they don't pass their thoughts down the ladder.
