Hill Harry, Fotheringham James, Potts Jessica, Solis-Trapala Ivonne, Lambie Mark, Damery Sarah, Allen Kerry, Wailoo Allan, Williams Iestyn, Davies Simon
School of Medicine and Population Health, University of Sheffield, Sheffield, UK.
Sheffield Kidney Institute, Northern General Hospital, Sheffield, UK.
Appl Health Econ Health Policy. 2025 May 25. doi: 10.1007/s40258-025-00976-7.
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.
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.
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.
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.
肾衰竭可以通过腹膜透析或家庭血液透析在家中进行治疗。人员配备减少、交通和间接费用降低，以及通过在家治疗提高生活质量，这些因素相结合可能使在家开始透析具有很高的成本效益。主要目标是评估与中心血液透析（ICHD）相比，让患者开始接受家庭透析治疗（HDT）的成本效益。次要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。
开发了一个多状态模型，该模型使用英国肾脏登记处的数据并结合全国调查数据，以估计患者和透析中心对透析治疗方式变化及每种方式持续时间的影响。这些数据被用作微观模拟的输入，以估计患者的终身质量调整生命年（QALY）和英国国家医疗服务体系（NHS）成本、HDT与ICHD相比的成本效益，以及消除HDT采用的特定障碍所带来的成本和健康结果差异。
与ICHD相比，开始接受HDT可带来额外的0.30个QALY，并节省15272英镑。HDT具有82%的成本效益概率。在多状态模型中，实施质量改进举措和缓解工作人员能力压力被确定为有影响力的因素。解决这些问题分别使生命年增加0.54和0.22，从而带来0.22和0.08的QALY增益，成本分别增加10059英镑和5127英镑。
与ICHD相比，让患者开始接受HDT具有成本效益。缓解透析中心工作人员能力压力并实施质量改进举措可改善健康状况，尽管由于医疗成本的相关增加，这些变化不具有成本效益。
