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‘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



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Authored by Prof John Agar. Copyright © 2012
Nocturnal Haemodialysis Program, Barwon Health.
All rights reserved. Revised: July 1st 2012