Haemodialysis at home
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Haemodialysis at Home. Sandip Mitra Central Manchester University Hospitals Foundation Trust. ESRD. Dialysis. Patients pmp worldwide. Worldwide surge in chronic kidney disease & ESRD Expanding dialysis population, an evolving disease Impressive and worrying mortality on dialysis

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Haemodialysis at Home

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Haemodialysis at home

Haemodialysis at Home

Sandip Mitra

Central Manchester University Hospitals Foundation Trust


Haemodialysis at home

ESRD

Dialysis

Patients pmp worldwide

  • Worldwide surge in chronic kidney disease & ESRD

  • Expanding dialysis population, an evolving disease

  • Impressive and worrying mortality on dialysis

  • Poor quality of life

1998 - 2008


A sound alternative

A Sound Alternative:

Home Haemodialysis

  • BetterPatientOutcomes

  • Cost Effectiveness

Home Haemodialysis


What do they have in common

What do they have in common?

Adding Product Value

Toyota Production System


Value quality access cost

VALUE = QUALITY * ACCESS COST

“the number of life years saved could be doubled if resources were reallocated

to more cost-effective interventions” . . .


Pricing human life years

Pricing Human Life(-Years)


Haemodialysis at home

Dialysis Cost Comparison NHS

Home haemodialysis annual sessions based on 4x weekly therapy.

PbR for Kidney Dialysis Project Group Report June 2009


Cost benefit league table cost qaly

Cost - benefit league table [Cost/QALY]

Treatment (£ Aug 1990)

Cholesterol testing and diet therapy only (all adults aged 40-69) 220

Neurosurgical intervention for head injury 240

Advice to stop smoking from general practitioner 270

Neurosurgical intervention for subarachnoid haemorrhage 490

Antihypertensive treatment to prevent stroke (ages 45-64) 940

Pacemaker implantation 1 100

Hip replacement 1 180

Valve replacement for aortic stenosis 1 140

Cholesterol testing and treatment 1 480

Coronary artery bypass graft (left main vessel disease, severe

angina) 2 090

Kidney transplant 4 710

Breast cancer screening 5 780

Heart transplantation 7 840

Cholesterol testing and treatment (incrementally) of all adults

aged 25-39 14 150

Home haemodialysis 17 260

Coronary artery bypass graft (one vessel disease, moderate

angina) 18 830

Continuous ambulatory peritoneal dialysis 19 870

Hospital haemodialysis 21 970

Erythropoietin treatment for anaemia in dialysis patients

(assuming 10% reduction in mortality) 54 380

Neurosurgical intervention for malignant intracranial tumours 107 780

Erythropoietin treatment for anaemia in dialysis patients

(assuming no increase in survival) 126 290

Dept of Health Economics Research , York


Haemodialysis at home

QALYs generated and costs accrued

HNHD=home nocturnal hemodialysis

IHD=In-hospital dialysis

McFarlane PA et al. Kidney Int 2006; 69:798-805.


Manchester home business model

Manchester Home Business Model

Philosophy

Flexible Training Centre

Use of existing HD stations with adaptations

Integrated Community support ( HHD 1:20patients)

In-House technical team

Staff – clinical lead (1 PA), training staff

Machine with basic interface, high reliability (F4008 home)

Standard conversion charge (£3000 - £5000)

Cost per therapy package

(Rx cost, machine lease cost, supplies)

Pro rata water and electricity rates

Education and staff training package

Carer support (Carer Grant)

Emergency helpline 24/7

Cabin installation (£12000) funding routes

Dedicated clinic

Social worker , Clinical Psychologist time


Haemodialysis at home

An Environment for Learning


Training activity 2004 2010

Training activity (2004-2010)

  • Total patients 171

  • Age 53 yrs (range 22 – 73 yrs)

  • Trained 140

  • Failed 8 , Tx 3, Retrained 11, training 16

  • AVF : 85 %

  • Diabetes 11 %


Haemodialysis at home

Home Haemodialysis Uptake

Patients = n

Manchester Point prevalence

Manchester , 12% of HD


Improving standards

Improving standards

Manchester Feb 2010


Set up location at home

Set up Location at Home

Home conversions cabin installation 10 % patients


Emergency helpline 24 7

Emergency Helpline 24/7


Haemodialysis at home

Cost per QALY - Home HD dominates

10 yr savings (50pts) > £ 1 million

CEP 10063, 2010


Quadrants of cost effectiveness

Quadrants of Cost Effectiveness

Hosp HD

National Information Center on Health Services Research and Health Care Technology (NICHSR)


Value quality access cost1

Different Types of Economic Analysis

Home Haemodialysis :

A Neglected Opportunity

VALUE = QUALITY * ACCESS COST


Thank you

Thank You


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