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Haemodialysis at Home

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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  1. Haemodialysis at Home Sandip Mitra Central Manchester University Hospitals Foundation Trust

  2. 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

  3. A Sound Alternative: Home Haemodialysis • BetterPatientOutcomes • Cost Effectiveness Home Haemodialysis

  4. What do they have in common? Adding Product Value Toyota Production System

  5. VALUE = QUALITY * ACCESS COST “the number of life years saved could be doubled if resources were reallocated to more cost-effective interventions” . . .

  6. Pricing Human Life(-Years)

  7. Dialysis Cost Comparison NHS Home haemodialysis annual sessions based on 4x weekly therapy. PbR for Kidney Dialysis Project Group Report June 2009

  8. 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

  9. QALYs generated and costs accrued HNHD=home nocturnal hemodialysis IHD=In-hospital dialysis McFarlane PA et al. Kidney Int 2006; 69:798-805.

  10. 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

  11. An Environment for Learning

  12. 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 %

  13. Home Haemodialysis Uptake Patients = n Manchester Point prevalence Manchester , 12% of HD

  14. Improving standards Manchester Feb 2010

  15. Set up Location at Home Home conversions cabin installation 10 % patients

  16. Emergency Helpline 24/7

  17. Cost per QALY - Home HD dominates 10 yr savings (50pts) > £ 1 million CEP 10063, 2010

  18. Quadrants of Cost Effectiveness Hosp HD National Information Center on Health Services Research and Health Care Technology (NICHSR)

  19. Different Types of Economic Analysis Home Haemodialysis : A Neglected Opportunity VALUE = QUALITY * ACCESS COST

  20. Thank You

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