‘How much bang for each buck’
Can more be done better, but for less?
One of the major problems when discussing/comparing dialysis funding is the ‘local’ nature of most dialysis funding agreements. This makes it very hard to compare one expenditure report with another. It can be done to a reasonable degree of accuracy, however, if it is clear what costs are built in and what are excluded.
We have published a detailed analysis of the costs of 6 treatments/week overnight HD at home (NHHD) compared to 3 treatments/week HD in a satellite facility.
Although the data is now 4-5 years old, the comparison being made in 2003/2004, it showed that despite doubling the treatment rate from 3 to 6 treatments/week, 6 x week NHHD still came out to be cheaper than 3 x week facility-based care.
A full description of this study can be found in:
Agar JWM, Knight RJ, Simmonds RE, Boddington JM, Waldron CM, Somerville CA. Nocturnal Haemodialysis: An Australian cost comparison with conventional satellite haemodialysis. Nephrology (Carlton) 10 (6), 557-570, December 2005
The data from this study is also summarized in the section titled ‘The Geelong Experience’
NHHD makes sound economic sense
6night/wk NHHD yields optimum clinical outcomes yet still undercuts the costs of satellite or in-centre conventional HD costs
Alternate night (3.5night/wk) NHHD, though less clinically optimal than 6/wk NHHD, is highly cost efficient
Striving for optimum and not just adequate dialysis must inevitably translate into greater patient choice of and flexibility in dialysis programs, allowing less costly programs (eg: NHHD) to help fund more expensive modalities (eg: short daily HD) and, thereby, adding flexibility and choice to the overall dialysis experience
Providing flexible, cost-effective dialysis regimes that cater for all clinical and lifestyle aspirations should be the aim of all dialysis services.
The days of a “one-size-fits-all-and-especially-the-dialysis-staff-roster” approach to dialysis are numbered.
Flexible dialysis programs are the way of the future
Flexible dialysis is affordable if cost effective yet clinically superior programs like NHHD (3.5-6nights/wk) are introduced to offset the expenses of high-cost dialysis schedules like daily short hour dialysis (see ‘modalities’ discussion above)
Flexible dialysis programs deliver benefits to all …
Benefits to patients, families and friends
Improved clinical outcomes for patients
Abolition of the ‘dialysis syndrome’ and its symptoms
Freedom of diet and fluid intake
Less of a ‘patient’ mentality with return of the loved family member to the family dynamic
Benefits to government
A lower overall cost of the dialysis program
Higher taxation contributions from re-employed patients
Lower social security outlays in patient/family support
Benefits to dialysis companies:
Increased volume of machines sold (4x)
Increased volume of consumables (up to 2x)
Low nursing, administration and support costs
Authored by Prof John Agar. Copyright © 2012