Cost-effectiveness of daily home haemodialysis versus in-centre haemodialysis: A propensity score matching analysis based on real-world data from the French healthcare system.

Abstract

Background Daily home haemodialysis (HD) offers several advantages over conventional 3-times-weekly in-centre HD, with better preservation of quality of life and treatment flexibility, but its costs and potential benefits on mortality are poorly understood. Methods Individual healthcare data from the French National Health Data System for patients with end-stage kidney disease undergoing dialysis cross-referenced with the French National Cost Scale of the health ministry. After exclusion of patients treated < 90 days, and those without a treatment schedule or incomplete data for a social disadvantage score, 42 605 patients were selected (28 317 prevalent and 14 288 incident HD patients). After propensity score matching, 265 incident patients (in-centre HD, n = 212; daily home HD, n = 53) and 765 prevalent patients (in-centre HD, n = 612; daily home HD, n = 153) were analysed. Findings The global cost of daily home HD in incident patients was lower than in-centre HD (€1403/week vs. €1652/week, respectively). In prevalent patients, the cost was also slightly lower for daily home haemodialysis than compared to in-centre haemodialysis (€1360/week vs. €1456/week, respectively). The gross death rate in incident patients treated by in-centre HD after a 2-year follow-up was 10·4 % vs. 1·9 % for patients treated by daily home HD (p = 0·049, at Chi² test; relative risk=5·5). Using a Cox proportional hazard regression model, in-centre HD was associated with a 7-fold higher risk of death (hazard ratio=7·888, p = 0·045). Interpretation Daily home HD is a more cost-effective and patient-centred treatment option than in-centre HD. Funding This research was funded by Physidia Ltd and Ramsay Health Care, France.