patient
Joined: 29 Oct 2002
Posts: 137
Posted: Sun Oct 05, 2003 8:55 am Post subject: Costs of in-center dialysis vs Home Hemo
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Can anyone provide a cost comparison on in-center vs home hemo and nocturnal? Does home care save $$$ or not?
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Lin
Joined: 28 Oct 2002
Posts: 337
Posted: Mon Oct 06, 2003 1:07 am Post subject: I've read
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that in studies from Canada, although it costs more initially for startup costs for a homecare pt. that in the long run it will save money. The problem is that companies have to be sure that a person will stay on home hemo long enough for it to benefit in cost savings for the company. The cost savings are even better now because those who do home hemo do not have paid helpers as Medicare and Ins. no longer pay for this.<
>Last week there was a very though provoking article on "rationing" the home hemo for dialysis pts.. In the article it gave Rogosin Institute in NYC as an example where they carefully scrutinize the home hemo applicants, accepting only those who they are sure will benefit and stay in the program. They only accept so many pts.. and are extremely carefull about who they pick! <
>There is a lively discussion on the above article and the benefits and cost savings (or not!) of home hemo on the Yahoo Dialysis Support board. Sure could use Marty's input! Lin.
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Marty
Joined: 28 Oct 2002
Posts: 160
Posted: Mon Oct 06, 2003 11:54 am Post subject: Cost Savings I think so.
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Today when we visited our "home" nephrologist. He was elated to tell me they were going to start a daily program with the "Askys". He said he would be happy if he could see all his patients as well as my father. Apparently Askys reps had come in and talked with the decision makers and it was a go. The word was then passed to our nephrologist they were genuinely willing to pay for it. This is how the decision was arrived at. 1. There are no home hemo programs at all available in our area. Lots of centers to draw patients from. 2. There will be no extra hiring expense. There PD patients are down and the PD nurse will train patients for the Askys. 3. Daily dialysis doesn't require the cost of monitoring. 4. The Askys reuses the blood lines etc. not a new set up cost each time. Just suppose they get 25 patients as we have in our current program, no additional staff, no extra tubing and dialyzer, no electric, no water. Once they train us we are very little maintance. I said but the machine cost $40,000 and this was the reply. We don't buy the machine we lease it. In business any equipment that you rent for the business is totally written off. That is why so many companies rent cars instead of buy them. So it finally became a win win situation. Good for the patient and money for the center.<
>Aside from this regarding slow nocturnal we were told directly when we started the program that it was costing them money and if they didn't get at least 16 patients "to
eak even" then the program may be stopped. But if it was stopped they would be sure we were in a "home hemo" program. We now have 25 patients. I doubt very much that the profit margin for slow nocturnal patients is as high as it would be for home hemo or Askys patients because we do no reuse and it does require additional staffing and the monitoring. However the staff for the 25 of us is a lot less than the staff requirements for 25 patients in-center and of course were picking up the tab on the electric, water.<
>I am not an authority on this subject and perhaps there are costs involved that I am unaware of. But from what I know and I sure don't know it all...It looks as though home hemo is a cost savings. <
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BP
Joined: 06 Oct 2003
Posts: 3
Posted: Mon Oct 06, 2003 11:59 am Post subject: Home is cheaper and better
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It's not even close. Even a newbe search on google, using the search term "home dialysis cost comparison" will give you more evidence than you could read in a week. Here is just about the most straight forward.<
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>McFarlane PA, Pierratos A, Redelmeier DA.<
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>Home Dialysis, St. Michael's Hospital, Toronto, Ontario, Canada. phil.mcfarlane@utoronto.ca<
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>BACKGROUND: Home nocturnal hemodialysis (HNHD) can improve clinical and biochemical factors in people with renal failure, but its cost-effectiveness relative to conventional in-center hemodialysis (IHD) is uncertain. We hypothesized that HNHD would provide more dialysis treatments at a lower total cost than IHD. <
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>METHODS: A prospective one-year descriptive costing study was performed at two centers in Toronto, Canada, involving patients enrolled from a HNHD program (N = 33), and a matched cohort from an IHD program (N = 23). All costs are expressed as mean weekly amount in Canadian year 2000 dollars. A projected mean annual cost (PMA) was calculated also. <
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>RESULTS: The mean number of treatments per week was much higher with HNHD (5.7 vs. 3.0, P = 0.004). Cost categories found to be less expensive for HNHD were staffing (weekly $210 vs. $423, P < 0.001, PMA $10,932 vs. $22,056) and overhead and support (weekly $80 vs. $238, P < 0.001, PMA $4179 vs. $12,393). There was a trend toward lower costs for hospital admissions and procedures (weekly $23 vs. $134, P = 0.355, PMA $1173 vs. $6997) and for medications ($172 vs. $231, P = 0.082, PMA $8989 vs. $12,029). Costs found to be more expensive for HNHD were the cost of direct hemodialysis materials (weekly $318 vs. $126, P < 0.001, PMA $16,587 vs. $6575) and capital costs (weekly $118 vs. $17, P < 0.001, PMA $6139 vs. $871), with a trend toward higher cost for laboratory tests (weekly $33 vs. $26, P = 0.094, PMA $1744 vs. $1364). Physician costs were the same at $128 per week (PMA $6650). The weekly mean total cost for health care delivery was 20% less for HNHD ($1082 vs. $1322, P = 0.006), with projected mean annual costs more than $10,000 lower ($56,394 vs. $68,935). <
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>CONCLUSIONS: HNHD provides about three times as many treatment hours at nearly a one-fifth lower cost, with savings evident even when only program and funding-specific costs are considered
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Lin
Joined: 28 Oct 2002
Posts: 337
Posted: Fri Oct 10, 2003 2:42 am Post subject: Other savings!
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Let's not forget that there are more and more people going on dialsyis, and they will need to build new centers to take care of them all, and that is extremely expensive. If on the other hand a percentage of pts. can be put on home hemo that will free up chairs in the units and save the providers money because they won't have to build new units. Of course, then they will be telling us pts. they are doing it for our benefit, but hey who cares! Bottom line is they aren't going to do something that doesn't directly benefit them, money in the pocket. If the AKSYS machine and programs using it can do that, it's a win/win situaution. I'm not that terribly far from upstate NY Marty; I'm hoping it trickles down. Lin.
