Patient experience: the case for home dialysis

We have just completed a major assessment of hospital, satellite and home dialysis delivery models.

We reviewed the efficacy and cost models associated with hospital, satellite and home dialysis models in multiple countries. In conclusion, whilst it’s not a one size fits all solution, home dialysis is a clear winner for the majority of people on dialysis.

Not only is a home dialysis solution 30-60% more cost effective over hospital and satellite models, it allows patients to perform dialysis in the comfort of their own home, significantly improving quality of life. No longer do patients have to visit a hospital or satellite centre 3 times per week/4-5 hours a session (incl. avg. commute time).

In addition, patients at home can perform nocturnal dialysis, which allows them to maintain a normal working life, which it itself results in wider benefits to the individual and society.

• There are 5 stages of Chronic Kidney Disease (CKD). Stage 5 is classified as end stage renal disease and is when a patient requires renal replacement therapy (transplant or dialysis)
• The Glomerular Filtration Rate (GFR) measures the amount of blood that passes through the tiny filters (glomeruli) in the kidneys, each minute
• The National Service Framework for Renal Services defies normal renal function as estimated GFR = />90 ml/min/1,73M2
• As Chronic Kidney disease (CKD) progresses the GFR falls
• Patients in ESRD have three treatment options:
  1) Conservative Treatment – manage symptoms of kidney failure via lifestyle changes
  2) Dialysis Treatment – conduct haemodialysis or peritoneal dialysis
  3) Kidney Transplant – replace kidney; more cost effective over 10 years than dialysis, but shortage of donors, means dialysis segment will grow
• Patients who commence dialysis can have their treatment at a hospital, satellite (standalone clinic) or home
• Haemodialysis and Peritoneal dialysis have similar long-term survival rates

• In England, there are an estimated 2.8m diagnosed and undiagnosed people (6.1%) of the population (>16 years old) that are thought to have CKD (Stage 3-5).
• In 2018, total population in England was ~56m, of which, >16 years old accounted for 45.4m (81%)
• CKD affects ~2.8m people over the age of 16. An estimated ~60,000 patients have End-Stage Renal Disease (ESRD), of which, ~30,000 are on dialysis
• Prevalence rates are rising, largely due to better detection (2.4% in 2007, 4.3% in 2010 and 6.1% in 2017), poor nutrition and lifestyles, which is likely to cause pressure on health budgets
• Prevalence of chronic kidney disease stage 3-5 is expected to increase to 3.2m people by 2021 and 4.2m by 2036
• There are ~40,000 premature deaths every year due to chronic kidney disease (that’s enough people to fill the Royal Albert Hall nine times over)
• Chronic kidney disease diminished quality of life for many people and represents a significant financial burden on the NHS
• Black, Asian and minority ethnic communities are five times more likely to develop chronic kidney disease than other groups

• NHS England spends £1.7bn per annum on CKD (more than the combined £1.4bn cost to treat breast, lung, colon and skin cancer)
• Patients with CKD are likely to develop other health conditions, namely Hypertension, Stroke and/or Myocardial Infarction, resulting in adjacent costs in other non renal areas
• Mean annual direct cost of Dialysis care per patient is estimated to be £577m/30,000 = £19,233
• Full reimbursement by NHS and free at point of care

Source: Public Health England, CKD Prevalence Estimates published in 2014; Chronic Kidney Disease in England – The Human and Financial Cost; Curzon Consulting analysis

Home dialysis solution is not for all patients. Based on our analysis, when home dialysis is utilised, it can cost up to 40-60% lower than dialysis performed in hospitals and 30-40% lower when compared with satellite clinics

The total annual cost of delivering APD and CAPD is substantially lower than that for HD.

Studies in Belgium, Canada, France, Germany, Italy, Japan, Netherlands, Spain, Sweden, Switzerland, UK and USA also found home-based modalities to be more cost effective.

In some countries, two patients can be treated on CAPD versus HD.

Despite overwhelming clinical and commercial evidence, home-based dialysis remains a small segment.

Payment models drive perverse incentives and therefore influence modality selection.

If you’d like to learn how to design and implement an evidence-based home dialysis proposition, which can significantly reduce cost and transform patient quality of life, please get in touch.