Direct and indirect costs of end-stage renal disease patients in the first and second years after initiation of nocturnal home haemodialysis, hospital haemodialysis and peritoneal dialysis

Abstract

Purpose: To estimate the direct and indirect costs of end-stage renal disease (ESRD) patients in the first and second years of initiating peritoneal dialysis (PD), hospital-based haemodialysis (HD) and nocturnal home HD. Methods: A cost analysis was performed to estimate the annual costs of PD, hospital-based HD and nocturnal home HD for ESRD patients from both the health service provider and societal perspectives. Empirical data on healthcare resource use, patients’ out-of-pocket costs, time spent on transportation and dialysis by ESRD patients, and time spent by caregivers were analysed. All costs were expressed in Hong Kong year 2017 dollars. Results: Analysis was based on 402 ESRD patients on maintenance dialysis (PD: 189; hospital-based HD: 170; and nocturnal home HD: 43). From the perspective of healthcare provider, hospital-based HD had the highest total annual direct medical costs in initial year (Hospital-based HD = $400,057±62,822; PD = $118,467±15,559; Nocturnal home HD = $223,358±18,055; p<0.001) and second year (Hospital-based HD = $360,924±63,014; PD = $80,796±15,820; Nocturnal home HD = $87,028±9,059; p<0.001). From the societal perspective, hospital-based HD had the highest total annual costs in initial year (Hospital-based HD = $452,151±73,327; PD = $189,191±61,735; Nocturnal home HD = $242,038±28,281; p<0.001) and second year (Hospital-based HD = $413,017±73,501; PD = $151,520±60,353; Nocturnal home HD = $105,708±23,853; p<0.001). Conclusions: This study quantified economic burden of ESRD patients, and assessed the annual healthcare and societal costs in the initial and second years of PD, hospital-based HD and nocturnal home HD in Hong Kong. From both perspectives, PD is cost-saving relative to hospital-based HD and nocturnal home HD, except that nocturnal home HD has the lowest cost in second year of treatment from the societal perspective. Results from this cost analysis facilitate economic evaluation in Hong Kong for health services and management targeted at ESRD patients.