Clinical Nephrology – Epidemiology – Clinical Trials
Kidney International (2003) 64, 1004–1011; doi:10.1046/j.1523-1755.2003.00157.x
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
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, Sunnybrook and Women's College Health Sciences Centre, Toronto, Ontario, Canada
Correspondence: 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
Received 28 January 2003; Revised 27 March 2003; Accepted 23 April 2003.
Abstract
The quality of life and cost utility of home nocturnal and conventional in-center hemodialysis.
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.
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.
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.
Conclusion
Home nocturnal hemodialysis is associated with a higher quality of life and a superior cost utility when compared to in-center hemodialysis.
Keywords:
economic analysis, hemodialysis, home, prospective studies, resource allocation
